Cumberland County COC Survey

Question Title

* 1. Please provide us with information about your agency.

Your agency name

Your name

Your agency's address

Your agency's phone number

How long has your agency operated?

Question Title

* 2. To which populations do you offer services?

Homeless individuals and families

Non-homeless individuals and families ONLY

All individuals and families, regardless of homeless status

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* 3. Which category best describes the main services your agency offers? Please check all that apply.

Crisis Intervention

Drug Addiction/Recovery

Housing assistance -- emergency

Housing assistance -- transitional

Housing assistance -- permanent

Meals Assistance

Medical Services

Mental Health Services

Utility Assistance

Vocational and Jobs Assistance

Other

Other (please specify)

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* 4. If there were additional dollars available to your agency to help support services to the homeless population, what would you do?

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* 5. What are the eligibility criteria for services through your agency (eg., gender, age, health condition, etc.)?

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* 6. Which homeless populations do you serve and approximately how many did you serve in 2013?

Chronically-homeless people

Families (with children)

Individuals

Minors

Mentally-ill people

Persons with HIV/AIDS

Prison Release

Substance abusers

Unaccompanied youth (age 18-24)

Veterans

Victims of Domestic Violence

Other

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* 7. HOUSING
Which of the following housing services do you provide to homeless people? Please indicate whether you provide direct services and/or referral services. Please check all that apply.

Other (please specify)

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* 8. SPECIALIZED SUPPORT SERVICES
Which of the following support services do you provide to homeless people? Please indicate whether you provide direct services and/or referral services. Please check all that apply.

	Direct Service	Referrals
Benefits assistance (SSI, etc)	Benefits assistance (SSI, etc) Direct Service	Benefits assistance (SSI, etc) Referrals
Budget/Credit Counseling	Budget/Credit Counseling Direct Service	Budget/Credit Counseling Referrals
Case management services	Case management services Direct Service	Case management services Referrals
Child Advocacy Services	Child Advocacy Services Direct Service	Child Advocacy Services Referrals
Dental Services	Dental Services Direct Service	Dental Services Referrals
Domestic Violence support	Domestic Violence support Direct Service	Domestic Violence support Referrals
Homelessness Prevention services	Homelessness Prevention services Direct Service	Homelessness Prevention services Referrals
Housing Search	Housing Search Direct Service	Housing Search Referrals
Medical Services	Medical Services Direct Service	Medical Services Referrals
Mental health services	Mental health services Direct Service	Mental health services Referrals
Outreach services	Outreach services Direct Service	Outreach services Referrals
Persons with HIV/AIDS	Persons with HIV/AIDS Direct Service	Persons with HIV/AIDS Referrals
Pregnancy services	Pregnancy services Direct Service	Pregnancy services Referrals
Rape Crisis support	Rape Crisis support Direct Service	Rape Crisis support Referrals
Substance Abuse Services	Substance Abuse Services Direct Service	Substance Abuse Services Referrals
Support Groups	Support Groups Direct Service	Support Groups Referrals
Transition Support for youth aging out of foster care	Transition Support for youth aging out of foster care Direct Service	Transition Support for youth aging out of foster care Referrals
Veterans assistance	Veterans assistance Direct Service	Veterans assistance Referrals
Other	Other Direct Service	Other Referrals

Other (please specify)

Question Title

* 9. GENERAL SUPPORT SERVICES
Which of the following support services do you provide to homeless people? Please indicate whether you provide direct services and/or referral services. Please check all that apply.

	Direct Service	Referrals
Clothing assistance	Clothing assistance Direct Service	Clothing assistance Referrals
Educational services	Educational services Direct Service	Educational services Referrals
Emergency financial assistance	Emergency financial assistance Direct Service	Emergency financial assistance Referrals
Emergency home repairs	Emergency home repairs Direct Service	Emergency home repairs Referrals
Food assistance	Food assistance Direct Service	Food assistance Referrals
Legal Services	Legal Services Direct Service	Legal Services Referrals
Meals	Meals Direct Service	Meals Referrals
Rental Assistance	Rental Assistance Direct Service	Rental Assistance Referrals
Translation/Interpreter services	Translation/Interpreter services Direct Service	Translation/Interpreter services Referrals
Transportation services	Transportation services Direct Service	Transportation services Referrals
Utilities assistance	Utilities assistance Direct Service	Utilities assistance Referrals
Vocational and Jobs assistance	Vocational and Jobs assistance Direct Service	Vocational and Jobs assistance Referrals
Other	Other Direct Service	Other Referrals

Other (please specify)

Cumberland County COC Survey

Welcome to the Cumberland County COC on Homelessness Survey

Question Title

* 1. Please provide us with information about your agency.

Question Title

* 2. To which populations do you offer services?

Question Title

* 3. Which category best describes the main services your agency offers? Please check all that apply.

Question Title

* 4. If there were additional dollars available to your agency to help support services to the homeless population, what would you do?

Question Title

* 5. What are the eligibility criteria for services through your agency (eg., gender, age, health condition, etc.)?

Question Title

* 6. Which homeless populations do you serve and approximately how many did you serve in 2013?

Question Title

* 7. HOUSING
Which of the following housing services do you provide to homeless people? Please indicate whether you provide direct services and/or referral services. Please check all that apply.

Question Title

* 8. SPECIALIZED SUPPORT SERVICES
Which of the following support services do you provide to homeless people? Please indicate whether you provide direct services and/or referral services. Please check all that apply.

Question Title

* 9. GENERAL SUPPORT SERVICES
Which of the following support services do you provide to homeless people? Please indicate whether you provide direct services and/or referral services. Please check all that apply.

Question Title

* 10. What do you see as gaps in the services offered to homeless people within Cumberland County and in the City of Fayetteville?

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* 11. What suggestions do you have for ways to close those gaps in services?

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* 12. Are you a developer offering housing units to homeless people?

	Direct Service	Referrals
Emergency Shelter – Families with children	Emergency Shelter – Families with children Direct Service	Emergency Shelter – Families with children Referrals
Emergency Shelter – Single males	Emergency Shelter – Single males Direct Service	Emergency Shelter – Single males Referrals
Emergency Shelter – Single females	Emergency Shelter – Single females Direct Service	Emergency Shelter – Single females Referrals
Emergency Shelter -- youth under 18	Emergency Shelter -- youth under 18 Direct Service	Emergency Shelter -- youth under 18 Referrals
Emergency Shelter – domestic violence victims	Emergency Shelter – domestic violence victims Direct Service	Emergency Shelter – domestic violence victims Referrals
Foster Care	Foster Care Direct Service	Foster Care Referrals
Permanent housing -- Families with children	Permanent housing -- Families with children Direct Service	Permanent housing -- Families with children Referrals
Permanent housing -- Single Males	Permanent housing -- Single Males Direct Service	Permanent housing -- Single Males Referrals
Permanent housing -- Single Females	Permanent housing -- Single Females Direct Service	Permanent housing -- Single Females Referrals
Permanent supportive housing for Disabled	Permanent supportive housing for Disabled Direct Service	Permanent supportive housing for Disabled Referrals
Rapid Re-Housing beds	Rapid Re-Housing beds Direct Service	Rapid Re-Housing beds Referrals
Transitional (Temporary) housing -- Families with children	Transitional (Temporary) housing -- Families with children Direct Service	Transitional (Temporary) housing -- Families with children Referrals
Transitional (Temporary) housing -- Single Males	Transitional (Temporary) housing -- Single Males Direct Service	Transitional (Temporary) housing -- Single Males Referrals
Transitional (Temporary) housing -- Single Females	Transitional (Temporary) housing -- Single Females Direct Service	Transitional (Temporary) housing -- Single Females Referrals
Other	Other Direct Service	Other Referrals

Question Title

* 1. Please provide us with information about your agency.

Question Title

* 2. To which populations do you offer services?

Question Title

* 3. Which category best describes the main services your agency offers? Please check all that apply.

Question Title

* 4. If there were additional dollars available to your agency to help support services to the homeless population, what would you do?

Question Title

* 5. What are the eligibility criteria for services through your agency (eg., gender, age, health condition, etc.)?

Question Title

* 6. Which homeless populations do you serve and approximately how many did you serve in 2013?

Question Title

* 7. HOUSINGWhich of the following housing services do you provide to homeless people? Please indicate whether you provide direct services and/or referral services. Please check all that apply.

Question Title

* 8. SPECIALIZED SUPPORT SERVICESWhich of the following support services do you provide to homeless people? Please indicate whether you provide direct services and/or referral services. Please check all that apply.

Question Title

* 9. GENERAL SUPPORT SERVICESWhich of the following support services do you provide to homeless people? Please indicate whether you provide direct services and/or referral services. Please check all that apply.

Question Title

* 10. What do you see as gaps in the services offered to homeless people within Cumberland County and in the City of Fayetteville?

Question Title

* 11. What suggestions do you have for ways to close those gaps in services?

Question Title

* 12. Are you a developer offering housing units to homeless people?

* 7. HOUSING
Which of the following housing services do you provide to homeless people? Please indicate whether you provide direct services and/or referral services. Please check all that apply.

* 8. SPECIALIZED SUPPORT SERVICES
Which of the following support services do you provide to homeless people? Please indicate whether you provide direct services and/or referral services. Please check all that apply.

* 9. GENERAL SUPPORT SERVICES
Which of the following support services do you provide to homeless people? Please indicate whether you provide direct services and/or referral services. Please check all that apply.