Appendix: Focus Group Survey Form
Basic Needs Focus Group Survey
Name of organization _____________________________________________
Your name and position____________________________________________
Address __________________________________Email _________________
__________________________________________Phone ________________
How long have you worked there? ____Years ____Months
What services/activities does your organization offer?
How long has your organization been providing basic needs services?
_____ Years ____ Dont know
How is your program funded? (Check all that apply and add percentages if known)
____ % Federal ____ % State ____ % County ____ % City
____ % Private ____ % Donations ____ % Other Dont know
How many staff/volunteers are involved in delivery of basic needs?
_____ Staff _____Volunteers ____ Dont know
Where does your organization/agency/program provide services?
a. Neighborhood (s) ________________________________________________________
b. Area (check as many as apply):
On average, how many customers/clients:
A. Do you serve in a month? ____ Customers/clients
B. Do you turn away in a month (due to lack of resources, staff or funds to serve them)? ____ Customers/clients
How do participants find out about your program?
Does your agency follow-up or track participants after providing services? How?