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Catholic Charities of The Diocese of Palm Beach Samaritan Center F. PROGRAM EVALUATION (Entire Section F not to exceed two pages) 1 . DEMOGRAPHICS : What information (data elements) will you need to collect in order to accurately describe your target population including demographics (age, gender, and ethnic background) required by the funder in Section H ? What are the pieces of information that qualify them for your target population ? How do you document their need for services or their " unacceptable condition requiring change" from Section Bl ? The Data elements collected for our target population are on our "Program Beneficiary Statistic form . The information collected is 1 ) Unduplicated count of program beneficiaries ; 2) Age group ; 3 ) Sex ; 4 ) Ethnic background 5 ) Program beneficiary characteristics (ex . Single parent, w/o GED or diploma, Veteran, Victim of rape/incest/domestic violence ; physically disabled) 6) Income level ; 7) Geographic residence in IRC ; 8 ) Unit of service including census days, special programs, transportation, legal & miscellaneous ; 9) Religion In addition , a monthly census form is kept by day on families that are in residence . This information is carried over to the above form at the end of each month . This information is collected and entered into the data form once they enter the program . The pieces of information that qualify them for our target population and their need is documented before entering the program . A telephone intake is the first step in assessing their need . If it appears that they qualify for our program , an appointment is scheduled to fully explain the program to them and to have them complete the following forms : 1 ) Samaritan Center Personal Inventory that is designed to obtain information about a wide range of possible problem areas ; 2) Subjective questionnaire (personal information including behaviors , mental health issues , dru (if/alcohol issues , etc. ) 3 ) A Statement regarding reason( s) or homelessness ; 4 ) Written assignment ( why they think they are a good candidate for program ; goals that they would like to accomplish and personal description of self Once this information has been completed, a determination can be made if this family tits into our target population , and depth of their need. 2 . MEASURES : What data elements will you need to collect to show that you have achieved (or made progress toward) your Measurable Outcomes in Section D ? What tools or items are you using as measures (grades, survey scores, attendance, absences , skill levels) for your program ? Are you getting baseline information from a source on your Collaboration List in Section E? Are there results from your Activities in Section D that need to be documented ? How often do you need to collect or follow- up on this data ? " Master Stats" which include : the information in the above form in addition to dates each family achieved a new Level , their Level at the time of exit, discharge information , forwarding address, phone and contact, 6 month contact information , 12 months contact information , rent/own home and whether employed . . . The tools/items used are pre-post tests, school grades , school attendance, counseling & parenting class attendance and the Level system . We have been asking our collaborative partners to administer pre and post tests but to date have been unsuccessful . We have been told that- we will receive them on future classes. 10