Provider Survey for sf4tay.org, an online directory of resources for 16-24 year old Transitional Age Youth (TAY)

This survey will help us compose a profile of your program to include on sf4tay.org, a comprehensive, searchable online directory of resources for 16-24 year old transitional age youth (TAY). Designed specifically for young adults, sf4tay.org will include comprehensive and up-to-date listings of all programs and services available to TAY, with all types of services—housing, workforce, education, health & wellness, advocacy, and recreation—included on one central site.

Please complete one survey for each program within your organization that works with young adults. The information you provide will help young people and their allies navigate the range of resources for transitional age youth and support informed referrals to appropriate services.

To ensure that your program is included when the site goes live in June, please take 15 minutes to complete the survey as soon as possible

Feel free to contact the SF4TAY Team at [email protected] or call (217) 341-4222 with any questions.

1. YOUR INFORMATION
   Please provide your contact information in case we have any questions about your survey responses.
2. Name/Title *
3. Phone Number *
4. Email Address *
   
   BASIC PROGRAM INFORMATION
5. 1. Name of Program *
6. 2. Name of Organization/Agency *
   
   3. Contact Information
   Please provide contact information for this program

   • Address *
   • Cross Street(s)  
   • Zip *
   • Public Transportation  
   • Phone Number *
   • Fax Number  
   • Website  
   • Facebook  
   • Twitter  

   4. Hours of Operation
   Please provide the hours of operation for this program

   • Monday *
   • Tuesday *
   • Wednesday *
   • Thursday *
   • Friday *
   • Saturday  
   • Sunday  

7. 5. Languages Spoken *
   Please indicate the languages that are spoken by staff
   English
   Spanish
   Mandarin
   Cantonese
   Other - Please Explain Below
   
   
   
8. 6. Cost *
   Please indicate the fees for this program, if any
     Free Sliding Scale or Other - Please Explain Below
   
   
   DETAILED PROGRAM INFORMATION
   
9. 7. Program Description *
   Please provide a brief descriotion of this program, as it would be explained to a young adult. This text will be used in your program profile.
   
   
10. 8. Program Abstract *
    Please provide a one-line abstract of this program. This text will be used when your program is listed among similar providers on the website.
    
    
11. 9. Program Goals/Outcomes *
    Please select the identified goal(s) or outcome(s) for participants in this program
    Stability/Meeting basic needs
    Basic academic skills (literacy, numeracy)
    Academic credentials
    Technical skills (career-related hard skills)
    Professional skills (career-related soft skills)
    Life skills (financial literacy, goal-setting, etc.)
    Self-advocacy/Resourcefulness skills
    Leadership skills
    Critical thinking skills
    Advocacy/organizing skills
    Internship placement or employment
    Wellness/healthy living skills
    Other - Please Explain Below
    
    
    
12. 10. Services Provided *
    Please select the core services that are provided through this program. This information will be used to categorize this program on the website.
    Emergency Services- Hotlines
    Emergency Services- Emergency Food and Shelter Services
    Emergency Services- Violence Response Resources
    Housing- Emergency Shelter
    Housing- Transitional Housing
    Housing- Affordable and Subsidized Housing
    Employment- Employment and Training Programs
    Employment- Jobs Search Assistance
    Employment- Professional Development
    Education- Literacy Support, Tutoring and College Preparation
    Education- High School Diploma and GED Programs
    Education- Higher Education
    Education- Career and Technical Education
    Health and Wellness- Physical Health
    Health and Wellness- Behavioral Health (mental health and substance abuse)
    Health and Wellness- Violence Response, Prevention, and Intervention
    Advocacy and Leadership
    Recreation
    Other - Please Explain Below
    
    
    
13. 11. Basic Needs Support Provided  
    Please select any basic needs supports that are available to participants through this program
    Housing assistance
    Food assistance
    Transportation assistance
    Child care
    Other - Please Explain Below
    
    
    
14. 12. On-Site Wraparound Support Services Provided  
    Please select any additional on-site wraparound support services that are available to participants through this program.
    On-site case management
    On-site mentoring
    On-site counseling/therapy
    Other - Please Explain Below
    
    
    
15. 13. Incentives/Benefits Provided  
    Please indicate any benefits or incentives that are provided to program participants
    Community service hours
    Gift cards
    Stipend
    Course credit (high school or college)
    Education Scholarship
    Hourly wage
    Other - Please Explain Below
    
    
    
16. 14. Weekly Time Commitment (Hours/Weeks)  
    Please estimate the approximate weekly time commitment for participants in this program
    
    
17. 15. Program Length  
    Please indicate the approximate duration of this program. If it does not have a defined length, please indicate the average time that participants take to complete the program
    
    
18. 16. Program Materials  
    Please attach any relevant program materials (fliers, brochures, etc.)
    
    POPULATIONS SERVED
    
19. 17. Ages Served *
    Please select the age group that is served by this program
      18-24 year olds exclusively 16-24 year olds exclusively 14-24 year olds exclusively 12-24 year olds exclusively All Adults over 18 years All Youth under 18 Other - Please Explain Below
    
    
    
20. 18. Population(s) Served *
    Please indicate which of the following populations of young people are BEST served by this program. Which of the following populations of young adults are MOST successful in this program?
    Justice-Involved and Reentry Young Adults
    Former Foster Youth/Young Adults Involved in Child Welfare System
    HIV Positive Young Adults
    Homeless Young Adults
    Immigrant Young Adults
    LGBTQQ Young Adults
    Young Adults with Disabilities or Other Special Needs
    Young Parents
    Young Veterans
    Homeless Young Adults
    Young Adults with Specific Medical or Behavior Health Diagnoses or Conditions
    Low-Income Young Adults
    African-American Young Adults
    Hispanic/Latino(a) Young Adults
    Asian/Pacific Islander Young Adults
    Young Men
    Young Women
    Other Populations - Please Explain Below
    
    
    
21. 19. Eligibility Requirements  
    Please indicate whether any of the following criteria serve as eligibility requirements that an applicant MUST meet in order to participate in this program
    Justice-Involved or Reentry
    Foster Care
    HIV Positive
    Homeless
    Immigrant
    LGBTQQ
    Disability or Other Special Need
    Pregnant/Parenting
    Veteran
    Medical or Behavior Health Diagnosis or Condition
    Low-Income
    Maximum/Minimum Age or Other - Please Explain Below
    
    
    
22. 20. Eligibility Restrictions  
    Please indicate whether any of the following additional criteria would DISQUALIFY an applicant from being eligible to participate in this program
    Serious Learning Disability
    Severe Mental Health Issues
    Substance Abuse Problem
    Criminal History/Probation Status
    Other - Please Explain Below
    
    
    ENROLLMENT INFORMATION
    
23. 21. Wait Time for Service *
    Please estimate the current wait time for accessing this program or service
    
    
24. 22. Admissions Process *
    Please select how new participants are admitted to this program
      Open Enrollment (noncompetitive, rolling admissions) Application (competitive admissions with set deadlines and program start dates) Other - Please Explain Below
    
    
    
25. 23. Admissions and Enrollment Process Description *
    Please explain the admissions and enrollment process in detail. What are the steps that a young person must complete in order to enroll in this program?
    
    
26. 24. Enrollment Requirements  
    Please indicate whether any of the following are required for enrollment into this program
    State Issued ID
    Social Security Card
    Proof of SF Residency
    Proof of Income
    Referral from another agency/institution or Other - Please Explain Below
    
    
    
27. 25. Enrollment Materials  
    Please attach any enrollment/application materials for this program
    
    26. Intake Person
    Please indicate the primary contact person for young adults who are interested in enrolling in this program.
    
28. Contact Person *
29. Contact Person's Title *
30. Phone Number *
31. Email Address  
    
    
32. 27. Logo  
    Please attach an image to include with this program listing
    
    
33.