YPA Rates Questionaire Organization Information Question Title * 1. What is your organization's name? Question Title * 2. Who is completing this form? (full name) Question Title * 3. What is your email address? Question Title * 4. What is your website address? Question Title * 5. What counties/boroughs do you provide youth peer services within? Question Title * 6. What age range do you provide youth peer services for? Question Title * 7. What settings do you provide youth peer services within? (Check as many as apply) Community State operated hospital Private hospital Residential Treatment Facility/Center Other (please specify) Question Title * 8. What is your current funding source(s) for youth peer services? Question Title * 9. If you currently bill for YPA services, what is your rate? Next