Housing Availability Survey
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1. Youth Housing Programs

Thank you for participating in this survey! This survey will help us figure out what programs are out there and what the gaps in services are, if any.

If you have multiple housing programs within your organization, please fill out one survey per program.

Thank you, again!

1. Program Information

Program Information Organization
Program Name
City Location

2. Program Contact Information

Program Contact Information Contact Persons Name
Title
Phone Number
Email Address

3. Program Type

These programs can be parenting or non-parenting...criteria is on the next page.

Program Type These programs can be parenting or non-parenting...criteria is on the next page. Emergency Housing

Transitional Living Program

Low-Income Housing/Apartments

Substance Abuse Program/Residential

Residential Treatment

Rent/Utility Assistance

Other (please specify)

4. Capacity

Capacity # Units - Male
# Beds - Male
# Units - Female
# Beds- Female

5. Average Daily Occupancy

Average Daily Occupancy Average # Full Units
Average # Full Beds

6. Allowed Duration of Stay

Allowed Duration of Stay Until this age:
For this amount of years:
Other:

7. Monthly Cost to Youth

Monthly Cost to Youth This $ amount per month:
This % of income per month:
Other:

8. Does monthly rent go towards savings account for youth?

Does monthly rent go towards savings account for youth? Yes, ALL of the rent paid is put in a savings account for the youth

Yes, a PORTION of the rent paid is put in a savings account for the youth

No, none of the rent paid is put in a savings account for the youth