Coordinated Access Survey

Question Title

1. What type of Organization do you represent?

Non-Profit

For-Profit

Government

Individual

Other

Question Title

2. Does your Organization receive any funding through the CoC?

Yes

Question Title

3. What Population do you serve? (Check all the apply)

Literal Homeless

Youth (18-24)

Domestic Violence Victims

Unaccompanied Youth (17 and under)

Other

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4. What Counties do you serve? (Check all that apply)

Hernando

Lake

Citrus

Sumter

Question Title

5. Please rate the following in order of priority (1 being highest and 5 being lowest)

Question Title

6. Select Two of the following you feel should be given priority over the others

Chronic Homeless (individual with a disabling condition who has either experienced homelessness for 12 months or loner or has had 4 or more episodes in the past 3 years.)

Those at Risk of being homeless

Elderly

Those fleeing Domestic Violence

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7. Select TWO of the following you feel should be given priority over the others

Length of time homeless

Substance abuse issues

Mental Health Issues

Length of time of the By Name List

Question Title

8. Select THREE of the following you feel should be given priority over the others

Tri-morbidity (co-occurring disorder (psychiatric, substance abuse) with a chronic medical condition

Current Palliative Health Care

Acuity (Mental acuity is sharpness of the mind. Things considered in determining a person's mental acuity are memory, focus, concentration, and understanding)

Physical/Chronic Health Issues

Pregnancy in family

Question Title

9. Select TWO of the following you feel should be given priority over the others

Sheltered (Emergency or Transitional Shelter)

Unsheltered

Length of time in CoC

Working current reunification case plan

Question Title

10. High utilizer of Mental Health facility Select ONE of the following you feel should be given priority over the others

High utilizer of Mental Health facility

High utilizer of Correctional facility

Hugh utilizer of Community Drop in Centers

High utilizer of Substance Abuse Treatment facility

Coordinated Access Survey

Question Title

* 1. What type of Organization do you represent?

Question Title

* 2. Does your Organization receive any funding through the CoC?

Question Title

* 3. What Population do you serve? (Check all the apply)

Question Title

* 4. What Counties do you serve? (Check all that apply)

Question Title

* 5. Please rate the following in order of priority (1 being highest and 5 being lowest)

Question Title

* 6. Select Two of the following you feel should be given priority over the others

Question Title

* 7. Select TWO of the following you feel should be given priority over the others

Question Title

* 8. Select THREE of the following you feel should be given priority over the others

Question Title

* 9. Select TWO of the following you feel should be given priority over the others

Question Title

* 10. High utilizer of Mental Health facility Select ONE of the following you feel should be given priority over the others

1. What type of Organization do you represent?

2. Does your Organization receive any funding through the CoC?

3. What Population do you serve? (Check all the apply)

4. What Counties do you serve? (Check all that apply)

5. Please rate the following in order of priority (1 being highest and 5 being lowest)

6. Select Two of the following you feel should be given priority over the others

7. Select TWO of the following you feel should be given priority over the others

8. Select THREE of the following you feel should be given priority over the others

9. Select TWO of the following you feel should be given priority over the others

10. High utilizer of Mental Health facility Select ONE of the following you feel should be given priority over the others