Youth Opportunity Landscape Survey - Hendricks Family Foundation

Organization*

Name*

First Last

Email*

Phone*

What is your organization's approximate budget for all youth service programs?*

Please enter a number

Programs

Provide the requested program information for each of your programs serving youth between the ages of 11 to 21.

How many programs fit the description?*

PROGRAM #1

Program Name*

Category*

If other, please specify.

Age Group*

Select all that apply

Middle School
High School
Post High School

Risk Level*

Low Risk
Moderate Risk
High Risk
All Youth

Key Outcome Objectives*

Identify up to 3 measures tracked to assess the impact of your program on the young people served. If you do not track outcomes please note accordingly.

Numbers served annually*

Please enter a #

Capacity Info*

Does your program have a waitlist, are you at capacity or do you have available capacity to serve additional youth (with your current program resources).

Waiting List
At Capacity
Available Capacity

Primary Funding Sources*

Please provide the two most significant sources of funding for your program.

Government
Private Grants
United Way
Fundraising/Private Donations
Program Revenue/Fee for Service

PROGRAM #2

Program Name*

Category*

If other, please specify.

Age Group*

Select all that apply

Middle School
High School
Post High School

Risk Level*

Key Outcome Objectives*

Identify up to 3 measures tracked to assess the impact of your program on the young people served. If you do not track outcomes please note accordingly.

Numbers served annually*

Please enter a #

Capacity Info*

Does your program have a waitlist, are you at capacity or do you have available capacity to serve additional youth (with your current program resources).

Waiting List
At Capacity
Available Capacity

Primary Funding Sources*

Please provide the two most significant sources of funding for your program.

Government
Private Grants
United Way
Fundraising/Private Donations
Program Revenue/Fee for Service

PROGRAM #3

Program Name*

Category*

If other, please specify.

Age Group*

Select all that apply

Middle School
High School
Post High School

Risk Level*

Key Outcome Objectives*

Identify up to 3 measures tracked to assess the impact of your program on the young people served. If you do not track outcomes please note accordingly.

Numbers served annually*

Please enter a #

Capacity Info*

Does your program have a waitlist, are you at capacity or do you have available capacity to serve additional youth (with your current program resources).

Waiting List
At Capacity
Available Capacity

Primary Funding Sources*

Please provide the two most significant sources of funding for your program.

Government
Private Grants
United Way
Fundraising/Private Donations
Program Revenue/Fee for Service

PROGRAM #4

Program Name*

Category*

If other, please specify.

Age Group*

Select all that apply

Middle School
High School
Post High School

Risk Level*

Key Outcome Objectives*

Identify up to 3 measures tracked to assess the impact of your program on the young people served. If you do not track outcomes please note accordingly.

Numbers served annually*

Please enter a #

Capacity Info*

Does your program have a waitlist, are you at capacity or do you have available capacity to serve additional youth (with your current program resources).

Waiting List
At Capacity
Available Capacity

Primary Funding Sources*

Please provide the two most significant sources of funding for your program.

Government
Private Grants
United Way
Fundraising/Private Donations
Program Revenue/Fee for Service

PROGRAM #5

Program Name*

Category*

If other, please specify.

Age Group*

Select all that apply

Middle School
High School
Post High School

Risk Level*

Key Outcome Objectives*

Identify up to 3 measures tracked to assess the impact of your program on the young people served. If you do not track outcomes please note accordingly.

Numbers served annually*

Please enter a #

Capacity Info*

Does your program have a waitlist, are you at capacity or do you have available capacity to serve additional youth (with your current program resources).

Waiting List
At Capacity
Available Capacity

Primary Funding Sources*

Please provide the two most significant sources of funding for your program.

Government
Private Grants
United Way
Fundraising/Private Donations
Program Revenue/Fee for Service