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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 B19 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 problems areas; 2) Subjective questionnaire (personal information including behaviors, mental health issues, drug/alcohol issues, etc. ) 3 ) A Statement regarding reason(s) or homelessness; 4) Written assignment (why they think they are a good candidate for the 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 fits into our target population, and the 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? The data elements needed to collect to show achievements/progress toward Measurable Outcomes are located in our "Master Stats" which include : the information in above form in addition to dates each family achieved a new Level, Level at 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 test, school grades, school attendance, counseling & parenting class attendance and the Level system. 13