Date
*
MM
DD
YYYY
Name of Organization
*
Email
*
Address
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Organization's Website:
*
Phone
*
(###)
###
####
Name of the Executive Director
Name & Title of Person Completing the Application
*
Briefly describe what your organization does for the homeless:
*
How long has your organization been operating in the Portland area?
*
How many paid staff members do you have? How many volunteers?
*
Please provide us with your previous year’s financial statement and your current year’s budget.
What is the target population that you serve?
*
For example, women with children, veterans, teens, etc
Is your target population typically:
Not homeless, but without your assistance they have the potential to become homeless
Recently homeless, less than one year
Chronically homeless, one year or longer
What are the top three underlying causes of homelessness that you address?
*
Is your mission to address the root causes of substance use addiction to enable program participants to achieve full recovery/sobriety?
If you make use of harm reduction, is it strictly considered an interim (time-limited) assistance in the process of achieving full recovery/sobriety?
If so, what is your time limit for harm reduction assistance?
In the previous year, how many people did you attempt to help with their underlying causes of homelessness?
*
Of these individuals, how many people did you successfully help last year?
*
On average, what percentage of those individuals who are housed, are still housed one year later?
*
