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2010 Membership Directory

 

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1. Basic information about the organization.

Basic information about the organization.   Company:
Address:
Address 2:
City/Town:
State:	-- select state --AL AlabamaAK AlaskaAS American SamoaAZ ArizonaAR ArkansasCA CaliforniaCO ColoradoCT ConnecticutDE DelawareDC District of ColumbiaFM Federated States of MicronesiaFL FloridaGA GeorgiaGU GuamHI HawaiiID IdahoIL IllinoisIN IndianaIA IowaKS KansasKY KentuckyLA LouisianaME MaineMH Marshall IslandsMD MarylandMA MassachusettsMI MichiganMN MinnesotaMS MississippiMO MissouriMT MontanaNE NebraskaNV NevadaNH New HampshireNJ New JerseyNM New MexicoNY New YorkNC North CarolinaND North DakotaMP Northern Mariana IslandsOH OhioOK OklahomaOR OregonPW PalauPA PennsylvaniaPR Puerto RicoRI Rhode IslandSC South CarolinaSD South DakotaTN TennesseeTX TexasUT UtahVT VermontVI Virgin IslandsVA VirginiaWA WashingtonWV West VirginiaWI WisconsinWY Wyoming
ZIP:
Email Address:
Phone Number:

2. If applicable, please indicate your web address.

If applicable, please indicate your web address.

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3. Please provide agency's mission statement.

Please provide agency's mission statement.

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4. Does your organization provide services to people who are homeless or at-risk of becoming homeless?

Does your organization provide services to people who are homeless or at-risk of becoming homeless?   Yes No Not sure

5. What type of funding does your organization receive?

What type of funding does your organization receive?   City of Detroit ESG or CDBG City of Detroit, other HUD McKinney Vento (SHP, S+C, etc) MSHDA Homeless Assistance Funding MSHDA, other Private Donations/Foundations

Other (please specify)

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6. Which homeless subpopulations (if any) does your organization serve?(Check all that apply)

Which homeless subpopulations (if any) does your organization serve?(Check all that apply)   Seriously Mentally Ill Substance Abusers Veterans People with HIV/AIDS Survivors of Domestic Violence Youth (under 18) Chronically Homeless (A chronically homeless person is an unaccompanied disabled individual who has been continuously homeless for a year or more or has had four episodes of homelessness in the past three years.) None

Other (please specify)

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7. What type of housing program does your organization provide?

What type of housing program does your organization provide?   Permanent Supportive Housing Transitional Housing Emergency Shelter(families) Emergency Shelter (singles) Supportive Service only program None

Other (please specify)

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8. What services does your organization provide? (check all that apply)

What services does your organization provide? (check all that apply)   Alcohol & Drug Abuse Case Management Child Care Counseling/Advocacy Education Employment Health Care HIV/AIDS Law Enforcement Legal Assistance Life Skills Mental Health Mobile Clinic Mortgage Assistance Rental Assistance Street Outreach Transportation Utilities Assistance Not Applicable (N/A)

Other (please specify)

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9. Briefly describe your organization’s programs and services. (include days/hours of services,and eligible population)
Example: Youth Outreach Program-food hygiene items, clothing and guidance for youth living on the street up to age 18 or 22 if homeless prior to turning 18. M-F 8 am-4 pm

Briefly describe your organization’s programs and services. (include days/hours of services,and eligible population) Example: Youth Outreach Program-food hygiene items, clothing and guidance for youth living on the street up to age 18 or 22 if homeless prior to turning 18. M-F 8 am-4 pm