1999 Basic Needs Assessment


 

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?

____ Food ____ Clothing ____ Housing/ Rental Assistance
    ____ Dont know
Other (Please List) ______________________________________
______________________________________________________

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):

City of Austin   Travis County
North Northwest Del Valle
South Southwest Jonestown
East Northeast Manor
West Southeast Oak Hill
Southwest Central Pflugerville
Other (please specify) _____________________________________________________

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?

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