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* 1. Today's Date

Date / Time

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* 2.  Name

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* 3. Name and Address of your Organization

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* 4. What year was your organization founded(an estimate is acceptable)

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* 5. Estimated number of employees at your organization as of today

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* 6. Estimate number of active volunteers as of today

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* 7. Select each geographic area(s) your organization serves

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* 8. All other counties in California, list your geographical area here

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* 9. Which of the following best describe your organization

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* 10. Which of the following does your organization serve (check those that apply)

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* 11. Estimate the average number of unduplicated individuals served by your organization on an annual basis

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* 12. Estimate the number of clients your organization serve annually who live below US poverty level guidelines ($11,490 annually) Please include children

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* 13. How many people under the age of 18 years old

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* 14. Estimate the average number of clients served above the age of 18

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* 15. Estimate how many women does your organization serve

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* 16. Estimate how many men

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* 17. Estimate how many identify as other

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* 18. What are the age ranges of the client your organization serves (Check all that apply)

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* 19. What percent of the following ethnicities does your organization serve(number only)

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* 20. Rank how you perceive hygiene and grooming services fit in with your client's basic needs, "1" being the most important, "6" being the least.

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* 21. Estimate how many people you serve lack access to hygiene and grooming services(percentage number, without the percent sign)

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* 22. Describe the problem of those lacking access to hygiene and grooming services and products in EACH of the following categories by listing a percentage(number only)

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* 23. Rank in matter of importance the services most needed(no duplicates)

  1 2 3 4 5 6
Haircuts
Hairstyling
Manicures
Styling Products
Hygiene Products
Styling Tools

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* 24. What are the barriers for the people you serve to receive grooming services and products (Check all that apply)

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* 25. What would be the impact of access to no-charge grooming services and products for the people you serve (Check all that apply)

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* 26. Does your organization received grooming and hygiene services already

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* 27. What has worked in the past

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* 28. What has not worked

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* 29. What are your organization’s barriers to offering grooming services, products and grooming tools to your clients (Check all that apply)

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* 30. Is there space to conduct the grooming services at your organization
(at least 7' by 7')

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* 31. Does your organization allocate money in the budget specifically for  grooming and hygiene services to your clients

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* 32. What is the current range for your organization’s budget (Check one)

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* 33. Does your organization have a volunteer program and/or volunteer coordinator

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* 34. As a condition of receiving grooming HwH, your clients must fill out a sign-in every participant that will measure the project's impact on their current condition. Do you agree to allow this process to take place?

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* 35. Funding

  Yes No
Will your organization fund your own grooming project
Have HwH seek funding
Underwrite our services through your budget
Speak with HwH first 
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