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Food Pantry

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					                                    City of Jersey City
                               Community Services Block Grant
                                  Quarterly Activity Report

INSTRUCTIONS:

By completeing the data requested below, the Quarterly Activity Report will calculate the totals
and reduce the need to enter data more than once.

Input data cells are shaded yellow on all forms.

INPUT DATA:

1. Name of Agency:                                 Your Agency

2. Name of Program:                                Your Program

3. Name of Director:                               Your Director

4. Name of Report Preparer:                        Preparer's name
                  Agency Name          Your Agency           Date Submitted
                 Program Name         Your Program                  Period:          Projections
                       Director       Your Director              Start Date:         10/1/2009
                                                                                                                          Food Pantry
                       Preparer      Preparer's name              End Date:          9/30/2010
                                       Services or
Goals    Problem, Need, Situation                                 Measure                Outcome             Measure
                                    Activities/Outputs
  1                2                        3                          4                     5                    6
Policy          Planning              Programming        Projection   Actual   YTD         Impact   Projection   Actual     YTD
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                  Agency Name          Your Agency           Date Submitted
                 Program Name         Your Program                  Period:          Projections
                       Director       Your Director              Start Date:         10/1/2009
                                                                                                                          Food Pantry
                       Preparer      Preparer's name              End Date:          9/30/2010
                                       Services or
Goals    Problem, Need, Situation                                 Measure                Outcome             Measure
                                    Activities/Outputs
  1                2                        3                          4                     5                    6
Policy          Planning              Programming        Projection   Actual   YTD         Impact   Projection   Actual     YTD
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                  Agency Name          Your Agency           Date Submitted
                 Program Name         Your Program                  Period:          Projections
                       Director       Your Director              Start Date:         10/1/2009
                                                                                                                          Food Pantry
                       Preparer      Preparer's name              End Date:          9/30/2010
                                       Services or
Goals    Problem, Need, Situation                                 Measure                Outcome             Measure
                                    Activities/Outputs
  1                2                        3                          4                     5                    6
Policy          Planning              Programming        Projection   Actual   YTD         Impact   Projection   Actual     YTD
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                  Agency Name          Your Agency           Date Submitted
                 Program Name         Your Program                  Period:          Projections
                       Director       Your Director              Start Date:         10/1/2009
                                                                                                                          Food Pantry
                       Preparer      Preparer's name              End Date:          9/30/2010
                                       Services or
Goals    Problem, Need, Situation                                 Measure                Outcome             Measure
                                    Activities/Outputs
  1                2                        3                          4                     5                    6
Policy          Planning              Programming        Projection   Actual   YTD         Impact   Projection   Actual     YTD
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                  Agency Name          Your Agency           Date Submitted
                 Program Name         Your Program                  Period:          Projections
                       Director       Your Director              Start Date:         10/1/2009
                                                                                                                          Food Pantry
                       Preparer      Preparer's name              End Date:          9/30/2010
                                       Services or
Goals    Problem, Need, Situation                                 Measure                Outcome             Measure
                                    Activities/Outputs
  1                2                        3                          4                     5                    6
Policy          Planning              Programming        Projection   Actual   YTD         Impact   Projection   Actual     YTD
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                  Agency Name          Your Agency           Date Submitted
                 Program Name         Your Program                  Period:          Projections
                       Director       Your Director              Start Date:         10/1/2009
                                                                                                                          Food Pantry
                       Preparer      Preparer's name              End Date:          9/30/2010
                                       Services or
Goals    Problem, Need, Situation                                 Measure                Outcome             Measure
                                    Activities/Outputs
  1                2                        3                          4                     5                    6
Policy          Planning              Programming        Projection   Actual   YTD         Impact   Projection   Actual     YTD
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Food Pantry


           Evaluation Tools

                   7
              Accountability

      A. Tools for Measurement




      B. Where Data Maintained




      C. Source of Data




      D. Frequency of Collection




      E. Processing of Data
Food Pantry


         Evaluation Tools

                   7
              Accountability
Food Pantry


         Evaluation Tools

                   7
              Accountability
Food Pantry


         Evaluation Tools

                   7
              Accountability
Food Pantry


         Evaluation Tools

                   7
              Accountability
Food Pantry


         Evaluation Tools

                   7
              Accountability
                                                      CITY OF JERSEY CITY
                                             DIVISION OF COMMUNITY DEVELOPMENT
                                           COMMUNITY SERVICES BLOCK GRANT (CSBG)
                                                  QUARTERLY ACTIVITY REPORT
Agency:                                                               Your Agency
Program:                                                             Your Program
Director:                          Your Director                                       Report Preparer:            Preparer's name
Reporting
Period:                       October, November, December                                         Date Submitted:
I.   STATISTICAL DATA
      A.     QUARTERLY STATISTICS
             1. New Participants
             2. Carry Overs/Duplicated
             3. Reporting Period Levels of Service                                                                              0

Total of Lines 1 and 2 must equal Line 3. All participants are considered new in the first quarter of the fiscal year.
     COUNT NEW PARTICIPANTS ONLY FOR SECTIONS B - F
      B.    Ethnic Breakdown
            Hispanic or Latino                                                  Not Hispanic or Latino
     B1.        Race

                                                                                                                                    Non-
                                              Hispanic Non-Hispanic                                                      Hispanic Hispanic
                White                                          Black/African American
                Asian                                          Asian & White
                American Indian/Alaskan Native
                Native Hawaiian/Other Pacific Islander
                American Indian/Alaskan Native & White
                Black/African American & White
                Am. Indian/Alaskan Native & Black/African American
                Asian/Pacific Islander
                Other Multi-Racial
      C.        Gender Identification:                                 Female                                   Male
      D.        Number of Female Heads of Household:
      E.        Number of Handicapped Persons Served:
      F.        Number of Homeless Persons Served:


All clients who are served in the First Quarter are considered NEW regardless of previous participation. Only those clients that were not reported in the First
Quarterly Report are considered new in the remaining reports.

I certify that the information contained in this quarterly activity report is true in all respects and in accordance with provisions of the contract.

Your Director
Executive Director                                                                Signature                                                    Date

                       B. Ethnic Breakdown                                            B1. Race (Hispanic)                           B1. Race (Non-Hispanic)


                      C. Gender Identification
II. eLogic Model
Please use this page to report how services provided are impacting your clients. Goals must coincide with the goals your agency has identified
in the subgrantee agreement.


  Problem,
                     Services or
   Need,                                             Measure                  Outcome                        Measure             Evaluation Tools
                  Activities/Outputs
  Situation
      2                   3                             4                        5                              6                        7
  Planning           Programming        Projection    Actual    YTD            Impact           Projection    Actual   YTD          Accountability
      0                   0                            #N/A                       0                           #N/A
                                            0                    0                                  0                   0    A. Tools for Measurement

                          0                            #N/A                       0                           #N/A                         0

                                            0                    0                                  0                   0                  0
                          0                            #N/A                       0                           #N/A                         0
                                            0                    0                                  0                   0                  0
                          0                            #N/A                       0                           #N/A                         0
                                            0                    0                                  0                   0    B. Where Data Maintained
                          0                            #N/A                       0                           #N/A                         0
                                            0                    0                                  0                   0                  0
                          0                            #N/A                       0                           #N/A                         0
                                            0                    0                                  0                   0                  0
      0                   0                            #N/A                       0                           #N/A                         0
                                            0                    0                                  0                   0    C. Source of Data
                          0                            #N/A                       0                           #N/A                         0
                                            0                    0                                  0                   0                  0
                          0                            #N/A                       0                           #N/A                         0
                                            0                    0                                  0                   0                  0
                          0                            #N/A                       0                           #N/A                         0
                                            0                    0                                  0                   0    D. Frequency of Collection
                          0                            #N/A                       0                           #N/A                         0
                                            0                    0                                  0                   0                  0
                          0                            #N/A                       0                           #N/A                         0
                                            0                    0                                  0                   0                  0
      0                   0                            #N/A                       0                           #N/A                         0
                                            0                    0                                  0                   0    E. Processing of Data
                          0                            #N/A                       0                           #N/A                         0
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                                             0          0       0          0



Please use additional sheets if necessary.
III. PROBLEMS (PLEASE EXPLAIN)




IV. PERSONNEL CHANGES

Please use this space to report any additions/terminations in personnel. (Be specific. List names, titles, and dates of change).




V. ADDITIONAL COMMENTS
                                                      CITY OF JERSEY CITY
                                             DIVISION OF COMMUNITY DEVELOPMENT
                                           COMMUNITY SERVICES BLOCK GRANT (CSBG)
                                                  QUARTERLY ACTIVITY REPORT
Agency:                                                               Your Agency
Program:                                                             Your Program
Director:                          Your Director                                       Report Preparer:            Preparer's name
Reporting
Period:                          January, February, March                                         Date Submitted:
I.   STATISTICAL DATA
      A.     QUARTERLY STATISTICS
             1. New Participants
             2. Carry Overs/Duplicated
             3. Reporting Period Levels of Service                                                                              0

Total of Lines 1 and 2 must equal Line 3. All participants are considered new in the first quarter of the fiscal year.
     COUNT NEW PARTICIPANTS ONLY FOR SECTIONS B - F
      B.    Ethnic Breakdown
            Hispanic or Latino                                                  Not Hispanic or Latino
     B1.        Race
                                                                                                                                    Non-
                                              Hispanic Non-Hispanic                                                      Hispanic Hispanic
                White                                          Black/African American
                Asian                                          Asian & White
                American Indian/Alaskan Native
                Native Hawaiian/Other Pacific Islander
                American Indian/Alaskan Native & White
                Black/African American & White
                Am. Indian/Alaskan Native & Black/African American
                Asian/Pacific Islander
                Other Multi-Racial
      C.        Gender Identification:                                 Female                                   Male
      D.        Number of Female Heads of Household:
      E.        Number of Handicapped Persons Served:
      F.        Number of Homeless Persons Served:


All clients who are served in the First Quarter are considered NEW regardless of previous participation. Only those clients that were not reported in the First
Quarterly Report are considered new in the remaining reports.

I certify that the information contained in this quarterly activity report is true in all respects and in accordance with provisions of the contract.

Your Director
Executive Director                                                                Signature                                                    Date
II. eLogic Model
Please use this page to report how services provided are impacting your clients. Goals must coincide with the goals your agency has identified
in the subgrantee agreement.

  Problem,
                     Services or
   Need,                                             Measure                  Outcome                        Measure             Evaluation Tools
                  Activities/Outputs
  Situation
      2                   3                             4                        5                              6                        7
   Planning          Programming        Projection    Actual    YTD            Impact           Projection    Actual   YTD          Accountability
      0                   0                            #N/A                       0                           #N/A
                                            0                    0                                  0                   0    A. Tools for Measurement
                          0                            #N/A                       0                           #N/A                         0

                                            0                    0                                  0                   0                  0
                          0                            #N/A                       0                           #N/A                         0
                                            0                    0                                  0                   0                  0
                          0                            #N/A                       0                           #N/A                         0
                                            0                    0                                  0                   0    B. Where Data Maintained
                          0                            #N/A                       0                           #N/A                         0
                                            0                    0                                  0                   0                  0
                          0                            #N/A                       0                           #N/A                         0
                                            0                    0                                  0                   0                  0
      0                   0                            #N/A                       0                           #N/A                         0
                                            0                    0                                  0                   0    C. Source of Data

                          0                            #N/A                       0                           #N/A                         0
                                            0                    0                                  0                   0                  0
                          0                            #N/A                       0                           #N/A                         0
                                            0                    0                                  0                   0                  0
                          0                            #N/A                       0                           #N/A                         0
                                            0                    0                                  0                   0    D. Frequency of Collection
                          0                            #N/A                       0                           #N/A                         0
                                            0                    0                                  0                   0                  0
                          0                            #N/A                       0                           #N/A                         0
                                            0                    0                                  0                   0                  0
      0                   0                            #N/A                       0                           #N/A                         0
                                            0                    0                                  0                   0    E. Processing of Data

                          0                            #N/A                       0                           #N/A                         0
                                            0                    0                                  0                   0                  0
                          0                            #N/A                       0                           #N/A                         0
                                            0                    0                                  0                   0                  0
                          0                            #N/A                       0                           #N/A                         0
                          0                                 0
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      0                   0                      #N/A       0       #N/A
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      0                   0                      #N/A       0       #N/A
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      0                   0                      #N/A       0       #N/A
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                          0                      #N/A       0       #N/A
                                             0          0       0          0
                          0                      #N/A       0       #N/A
                                             0          0       0          0


Please use additional sheets if necessary.
III. PROBLEMS (PLEASE EXPLAIN)




IV. PERSONNEL CHANGES

Please use this space to report any additions/terminations in personnel. (Be specific. List names, titles, and dates of change).




V. ADDITIONAL COMMENTS
                                                     CITY OF JERSEY CITY
                                            DIVISION OF COMMUNITY DEVELOPMENT
                                          COMMUNITY SERVICES BLOCK GRANT (CSBG)
                                                 QUARTERLY ACTIVITY REPORT
Agency:                                                               Your Agency
Program:                                                             Your Program
Director:                          Your Director                                       Report Preparer:            Preparer's name
Reporting
Period:                               April, May, June                                            Date Submitted:
I.   STATISTICAL DATA
      A.     QUARTERLY STATISTICS
             1. New Participants
             2. Carry Overs/Duplicated
             3. Reporting Period Levels of Service                                                                               0

Total of Lines 1 and 2 must equal Line 3. All participants are considered new in the first quarter of the fiscal year.
     COUNT NEW PARTICIPANTS ONLY FOR SECTIONS B - F
      B.    Ethnic Breakdown
            Hispanic or Latino                                                  Not Hispanic or Latino
     B1.        Race
                                              Hispanic Non-Hispanic                                                             N
                                                                                                                         Hispanic on-Hispanic
                White                                          Black/African American
                Asian                                          Asian & White
                American Indian/Alaskan Native
                Native Hawaiian/Other Pacific Islander
                American Indian/Alaskan Native & White
                Black/African American & White
                Am. Indian/Alaskan Native & Black/African American
                Asian/Pacific Islander
                Other Multi-Racial
      C.        Gender Identification:                                 Female                                   Male
      D.        Number of Female Heads of Household:
      E.        Number of Handicapped Persons Served:
      F.        Number of Homeless Persons Served:


All clients who are served in the First Quarter are considered NEW regardless of previous participation. Only those clients that were not reported in the First
Quarterly Report are considered new in the remaining reports.

I certify that the information contained in this quarterly activity report is true in all respects and in accordance with provisions of the contract.

Your Director
Executive Director                                                                Signature                                                    Date
II. ACCOMPLISHMENTS
Please use this page to report how services provided are impacting your clients. Goals must coincide with the goals your agency has identified
in the subgrantee agreement.

  Problem,
                     Services or
   Need,                                             Measure                  Outcome                        Measure             Evaluation Tools
                  Activities/Outputs
  Situation
      2                   3                             4                        5                              6                        7
  Planning           Programming        Projection    Actual    YTD            Impact           Projection    Actual   YTD          Accountability
      0                   0                            #N/A                       0                           #N/A
                                            0                    0                                  0                   0    A. Tools for Measurement
                          0                            #N/A                       0                           #N/A                         0

                                            0                    0                                  0                   0                  0
                          0                            #N/A                       0                           #N/A                         0
                                            0                    0                                  0                   0                  0
                          0                            #N/A                       0                           #N/A                         0
                                            0                    0                                  0                   0    B. Where Data Maintained
                          0                            #N/A                       0                           #N/A                         0
                                            0                    0                                  0                   0                  0
                          0                            #N/A                       0                           #N/A                         0
                                            0                    0                                  0                   0                  0
      0                   0                            #N/A                       0                           #N/A                         0
                                            0                    0                                  0                   0    C. Source of Data
                          0                            #N/A                       0                           #N/A                         0
                                            0                    0                                  0                   0                  0
                          0                            #N/A                       0                           #N/A                         0
                                            0                    0                                  0                   0                  0
                          0                            #N/A                       0                           #N/A                         0
                                            0                    0                                  0                   0    D. Frequency of Collection
                          0                            #N/A                       0                           #N/A                         0
                                            0                    0                                  0                   0                  0
                          0                            #N/A                       0                           #N/A                         0
                                            0                    0                                  0                   0                  0
      0                   0                            #N/A                       0                           #N/A                         0
                                            0                    0                                  0                   0    E. Processing of Data
                          0                            #N/A                       0                           #N/A                         0
                                            0                    0                                  0                   0                  0
                          0                            #N/A                       0                           #N/A                         0
                                            0                    0                                  0                   0                  0
                          0                            #N/A                       0                           #N/A                         0
                          0                                 0
                                             0          0       0          0   0
                          0                      #N/A       0       #N/A       0
                                             0          0       0          0   0
                          0                      #N/A       0       #N/A       0
                                             0          0       0          0   0
      0                   0                      #N/A       0       #N/A
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                          0                      #N/A       0       #N/A
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                          0                      #N/A       0       #N/A
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                          0                      #N/A       0       #N/A
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                          0                      #N/A       0       #N/A
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                          0                      #N/A       0       #N/A
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      0                   0                      #N/A       0       #N/A
                                             0          0       0          0
                          0                      #N/A       0       #N/A
                                             0          0       0          0
                          0                      #N/A       0       #N/A
                                             0          0       0          0
                          0                      #N/A       0       #N/A
                                             0          0       0          0
                          0                      #N/A       0       #N/A
                                             0          0       0          0
                          0                      #N/A       0       #N/A
                                             0          0       0          0
      0                   0                      #N/A       0       #N/A
                                             0          0       0          0
                          0                      #N/A       0       #N/A
                                             0          0       0          0
                          0                      #N/A       0       #N/A
                                             0          0       0          0
                          0                      #N/A       0       #N/A
                                             0          0       0          0
                          0                      #N/A       0       #N/A
                                             0          0       0          0
                          0                      #N/A       0       #N/A
                                             0          0       0          0


Please use additional sheets if necessary.
III. PROBLEMS (PLEASE EXPLAIN)




IV. PERSONNEL CHANGES

Please use this space to report any additions/terminations in personnel. (Be specific. List names, titles, and dates of change).




V. ADDITIONAL COMMENTS
                                                     CITY OF JERSEY CITY
                                            DIVISION OF COMMUNITY DEVELOPMENT
                                          COMMUNITY SERVICES BLOCK GRANT (CSBG)
                                                 QUARTERLY ACTIVITY REPORT
Agency:                                                               Your Agency
Program:                                                             Your Program
Director:                          Your Director                                       Report Preparer:            Preparer's name
Reporting
Period:                           July, August, September                                         Date Submitted:
I.   STATISTICAL DATA
      A.     QUARTERLY STATISTICS
             1. New Participants
             2. Carry Overs/Duplicated
             3. Reporting Period Levels of Service                                                                               0

Total of Lines 1 and 2 must equal Line 3. All participants are considered new in the first quarter of the fiscal year.
     COUNT NEW PARTICIPANTS ONLY FOR SECTIONS B - F
      B.    Ethnic Breakdown
            Hispanic or Latino                                                  Not Hispanic or Latino
     B1.        Race
                                              Hispanic Non-Hispanic                                                             N
                                                                                                                         Hispanic on-Hispanic
                White                                          Black/African American
                Asian                                          Asian & White
                American Indian/Alaskan Native
                Native Hawaiian/Other Pacific Islander
                American Indian/Alaskan Native & White
                Black/African American & White
                Am. Indian/Alaskan Native & Black/African American
                Asian/Pacific Islander
                Other Multi-Racial
      C.        Gender Identification:                                 Female                                   Male
      D.        Number of Female Heads of Household:
      E.        Number of Handicapped Persons Served:
      F.        Number of Homeless Persons Served:


All clients who are served in the First Quarter are considered NEW regardless of previous participation. Only those clients that were not reported in the First
Quarterly Report are considered new in the remaining reports.

I certify that the information contained in this quarterly activity report is true in all respects and in accordance with provisions of the contract.

Your Director
Executive Director                                                                Signature                                                    Date
II. ACCOMPLISHMENTS
Please use this page to report how services provided are impacting your clients. Goals must coincide with the goals your agency has identified
in the subgrantee agreement.

  Problem,
                     Services or
   Need,                                             Measure                  Outcome                        Measure             Evaluation Tools
                  Activities/Outputs
  Situation
      2                   3                             4                        5                              6                        7
  Planning           Programming        Projection    Actual    YTD            Impact           Projection    Actual   YTD          Accountability
      0                   0                            #N/A                       0                           #N/A
                                            0                    0                                  0                   0    A. Tools for Measurement
                          0                            #N/A                       0                           #N/A                         0

                                            0                    0                                  0                   0                  0
                          0                            #N/A                       0                           #N/A                         0
                                            0                    0                                  0                   0                  0
                          0                            #N/A                       0                           #N/A                         0
                                            0                    0                                  0                   0    B. Where Data Maintained
                          0                            #N/A                       0                           #N/A                         0
                                            0                    0                                  0                   0                  0
                          0                            #N/A                       0                           #N/A                         0
                                            0                    0                                  0                   0                  0
      0                   0                            #N/A                       0                           #N/A                         0
                                            0                    0                                  0                   0    C. Source of Data
                          0                            #N/A                       0                           #N/A                         0
                                            0                    0                                  0                   0                  0
                          0                            #N/A                       0                           #N/A                         0
                                            0                    0                                  0                   0                  0
                          0                            #N/A                       0                           #N/A                         0
                                            0                    0                                  0                   0    D. Frequency of Collection
                          0                            #N/A                       0                           #N/A                         0
                                            0                    0                                  0                   0                  0
                          0                            #N/A                       0                           #N/A                         0
                                            0                    0                                  0                   0                  0
      0                   0                            #N/A                       0                           #N/A                         0
                                            0                    0                                  0                   0    E. Processing of Data
                          0                            #N/A                       0                           #N/A                         0
                                            0                    0                                  0                   0                  0
                          0                            #N/A                       0                           #N/A                         0
                                            0                    0                                  0                   0                  0
                          0                            #N/A                       0                           #N/A                         0
                          0                                 0
                                             0          0       0          0   0
                          0                      #N/A       0       #N/A       0
                                             0          0       0          0   0
                          0                      #N/A       0       #N/A       0
                                             0          0       0          0   0
      0                   0                      #N/A       0       #N/A
                                             0          0       0          0
                          0                      #N/A       0       #N/A
                                             0          0       0          0
                          0                      #N/A       0       #N/A
                                             0          0       0          0
                          0                      #N/A       0       #N/A
                                             0          0       0          0
                          0                      #N/A       0       #N/A
                                             0          0       0          0
                          0                      #N/A       0       #N/A
                                             0          0       0          0
      0                   0                      #N/A       0       #N/A
                                             0          0       0          0
                          0                      #N/A       0       #N/A
                                             0          0       0          0
                          0                      #N/A       0       #N/A
                                             0          0       0          0
                          0                      #N/A       0       #N/A
                                             0          0       0          0
                          0                      #N/A       0       #N/A
                                             0          0       0          0
                          0                      #N/A       0       #N/A
                                             0          0       0          0
      0                   0                      #N/A       0       #N/A
                                             0          0       0          0
                          0                      #N/A       0       #N/A
                                             0          0       0          0
                          0                      #N/A       0       #N/A
                                             0          0       0          0
                          0                      #N/A       0       #N/A
                                             0          0       0          0
                          0                      #N/A       0       #N/A
                                             0          0       0          0
                          0                      #N/A       0       #N/A
                                             0          0       0          0


Please use additional sheets if necessary.
III. PROBLEMS (PLEASE EXPLAIN)




IV. PERSONNEL CHANGES

Please use this space to report any additions/terminations in personnel. (Be specific. List   names, titles, and dates of change).




V. ADDITIONAL COMMENTS
                     Goals
                     Goals
The number of low-income individuals served by
Community Action who sought emergency assistance
and the number of those individuals for whom
assistance was provided.
                   CAMP e Logic Model™
                           Column 2
                  PROBLEM, NEEDS, SITUATION
Low-income families/individuals do not have adequate resources to
purchase food to meet their dietary requirements.
                                                                          Click here to allow
                                                                           deletion of 'New'
                        CAMP e Logic Model™                                    Activities

                                 Column 3
          SERVICES OR ACTIVITIES/OUTPUTS AND BENCHMARKS                         UNITS
Provide a balanced food package to low-income individuals and families.   Persons
Provide vouchers for purchase of a balanced food package.                 Persons
other   Other
                                                                                    Click here to allow
                                                                                     deletion of 'New'
                        CAMP e Logic Model™                                             Outcomes

                                  Column 5
             ACHIEVEMENT OUTCOMES GOALS AND INDICATORS                                      UNITS
Individuals/Families have an adequate supply of nutritional food to prevent hunger on Persons
a temporary basis.
other   other
              CAMP eLogic Model™
A. Tools For Measurement
   Bank accounts
   Construction log
   Database
   Enforcement log
   Financial aid log
   Intake log
   Interviews
   Mgt. Info. System-automated
   Mgt. Info. System-manual
   Outcome scale(s)
   Phone log
   Plans
   Pre-post tests
   Post tests
   Program specific form(s)
   Questionnaire
   Recruitment log
   Survey
   Technical assistance log
   Time sheets
B. Where Data Maintained
   Agency database
   Centralized database
   Individual case records
   Local precinct
   Public database
   School
   Specialized database
   Tax Assessor database
   Training center
C. Source of Data
   Audit report
   Business licenses
   Certificate of Occupancy
   Code violation reports
   Counseling reports
   Employment records
   Engineering reports
   Environmental reports
   Escrow accounts
   Financial reports
   GED certification/diploma
   Health records
   HMIS
   Inspection results
   Lease agreements
   Legal documents
   Loan monitoring reports
   Mortgage documents
   Payment vouchers
   Permits issued
   Placements
   Progress reports
   Referrals
   Sale documents
   Site reports
   Statistics
   Tax assessments
   Testing results
   Waiting lists
   Work plan reports
D. Frequency of Collection
   Daily
   Weekly
   Monthly
   Quarterly
   Biannually
   Annually
   Upon incident
E. Processing of Data
   Computer spreadsheets
   Flat file database
   Manual tallies
   Relational database
   Statistical database

				
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