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* 1. Disclaimer: Please note that completing our online assessment does not guarantee the delivery of no-charge grooming services. Our service delivery to the community will be based on the availability of funds and manpower.

Note: DO NOT ENTER COMMAS WITHIN ANY NUMERICAL TEXT BOXES ON YOUR ANSWERS. ALL QUESTIONS MUST BE ANSWERED. YOU CANNOT SAVE AND RETURN TO THIS APPLICATION AT A LATER TIME. 

Note: YOU CANNOT SAVE AND RETURN TO YOUR ANSWERS AT A LATER TIME, THEREFORE THE BEST WAY TO COMPLETE THIS ONLINE ASSESSMENT IS TO... 
         1) PRINT OUT A COPY
         2) GATHER YOUR ANSWERS
         3) RETURN TO THIS ONLINE VERSION AND FILL IN YOUR ANSWERS

Date

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* 2. Person filling out this survey

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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 staff at your organization

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* 6. Estimated number of active volunteers

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* 7. Description of your organization (Check all that apply)

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* 8. Select each geographic area(s) served by your organization (check all that apply)

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* 9. Estimate the average number of non-duplicated individuals served by your organization on an annual basis

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

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* 11. Estimate the average total number of clients served below the age of 18 annually

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* 12. Estimate the average total number of clients served above the age of 18 annually

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* 13. Estimate the total number of male clients served annually

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* 14. Estimate the total number of female clients served annually

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* 15. Estimate the percentages of ethnic groups served by your organization annually in the boxes below (do not place the % symbol in the text box)

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* 16. Of the total non-duplicated clients served annually, estimate the amount that you believe lack access to regular grooming services and products

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* 17. As it relates to their income, rank where you believe your clients usually prioritize the cost of regular grooming services with "1" being highest priority and "8" being lowest priority (all items must be ranked)

  1 2 3 4 5 6 7 8
Housing
Childcare
Transportation
Grooming Services
Food
Healthcare
Clothing
Education

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* 18. Select common grooming/hygiene problem(s) that you observe when interacting with your clients. (Check all that apply)

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* 19. Rank in order the common grooming/hygiene problems that you observe with "1" being the most observed and "5" being least observed (all items must be ranked)

  1 2 3 4 5
Unkempt/unstyled hair
Uncut hair
Unclean hair
Body odor
Dental issues

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* 20. Select the gender(s) you serve who are in need of regular grooming services

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* 21. Rank in order the gender you serve who is most in need of grooming services and products with "1" being the primary gender in need (all items must be ranked)

  1 2
Male
Female

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* 22. Select the age group(s) who you serve that are in need of grooming services and products (select all that apply)

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* 23. Rank in order the age group(s) who you serve with "1" being the age group who is most in need of grooming services and "5" being the age group least in need. (all items must be ranked)

  1 2 3 4 5
0-18
18-30
30-50
50-65
65 and up

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* 24. What type of grooming support services are your clients unable to afford? (check all that apply)

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* 25. Rank in order the services needed by the clients of your organization with "1" being the service most needed to "6" being the service least needed. (all items must be ranked)

  1 2 3 4 5 6
Haircuting Services
Hairstyling Services
Grooming Products (gels, sprays, shampoos, conditioner, etc.)
Grooming Equipment (blow dryers, curling irons, brushes, razors, combs, etcs.)
Grooming Training Session for Clients and/or Staff
Chemical Services (permenent waves, relaxers, color treatment, etc.)

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* 26. Check any barrier(s) to your clients access to regular grooming services

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* 27. Rank in order your clients barrier(s) to regular grooming services and products with "1" being the greatest barrier and "5" the least barrier. All items must be ranked (including "none")

  1 2 3 4 5
Unable to afford regular grooming services
Lacks sufficient transportation to attend barber and/or beauty salon
Unaware of the locations of barber and beauty salons in the community
Lack of physical mobility and/or health issuses
None

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* 28. Check what would be the increased benefit(s) to your clients if they receive regular access to no-charge grooming services and products (check all that apply)

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* 29. Rank in order those same increased benefits with "1" being the greatest impact to "7" being the least impact of regular access no-charge grooming service to your clients. All items must be ranked (including "none")

  1 2 3 4 5 6 7
Clients will now have improved grooming and hygiene
Clients will now have maintained grooming and hygiene
Clients will now be able to attend job interviews with a neat and clean appearance
Clients will now be able to attend to attend their place of employment with a neat and clean apprearance
Clients will now be able to have access to products and services the were currently be able to afford
Clients will now be able to attend school with a neat and clean appearance
None

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* 30. List any other way(s) that no-charge grooming serivces will benefit your organization's clients (if there are no additional benefits place "N/A" in each textbox).

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* 31. If any, what are your organization's barriers to providing grooming services to your clients? Check all that apply, then list any other barriers if applicable

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* 32. Rank in order what are your organization's barriers to providing grooming services to your clients with "1" being the greatest barrier and "6" being the least greatest barrier. All items must be ranked (including "no barriers")

  1 2 3 4 5 6
No barriers
Lack of a volunteer program that will enlist a professional barber and/or hairstylist
Lack of available funds to hire a professional barber and/or stylist
Lack of technical assistance on how we can operate our own barber/beauty area in our facility
Lack of funding to operate a full-service barber/beauty area in our facility
Lack of available personnel to oversee a barber/beauty area in our facility

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

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* 34. Does your organization allocate money in the budget specifically to provide grooming services to your clients?

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* 35. What is the current range of your organization's annual budget

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

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* 37. As a condition of receiving grooming services and/or products from the RBCF, your clients must fill out a sign-in form that will measure the project's impact on their current condition. Do you agree to allow this sign-in process to take place?

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* 38. Would your organization like to...

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* 39. List the name, title, phone and email of the individual who can be assigned as a contact person for the RBCF

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