YOUR INFORMATION
Please provide your contact information in case we have any questions about your survey responses.
Name/Title *
Phone Number *
Email Address *
BASIC PROGRAM INFORMATION
1. Name of Program *
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
5. Languages Spoken *
Please indicate the languages that are spoken by staff
English
Spanish
Mandarin
Cantonese
Other - Please Explain Below
6. Cost *
Please indicate the fees for this program, if any
Free
Sliding Scale or Other - Please Explain Below
DETAILED PROGRAM INFORMATION
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.
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.
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
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
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
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
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
14. Weekly Time Commitment (Hours/Weeks)
Please estimate the approximate weekly time commitment for participants in this program
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
16. Program Materials
Please attach any relevant program materials (fliers, brochures, etc.)
POPULATIONS SERVED
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
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
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
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
21. Wait Time for Service *
Please estimate the current wait time for accessing this program or service
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
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?
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
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.
Contact Person *
Contact Person's Title *
Phone Number *
Email Address
27. Logo