Program Performance Report

Reporting Period:*

Q1: October 1, 2025 through December 31, 2025Q2: October 1, 2025 through March 31, 2026Q3: October 1, 2025 through June 30, 2026Q4: October 1, 2025 through September 30, 2026

Agency Name*

Service Name:*

If this service is Transportation (Volunteer & Dynamic), Caregiver Support (Group or Individual), or Kinship Support (Group or Individual), please combine all units and participant data when entering amounts in the Service Status Data section below. Note: Transportation, Caregiver Support, and Kinship Support are considered one service when entering data into NAPIS.

Contact Person's Name:*

Contact Person's Email*

example@example.com

Select One or More Counties Served:

Example:

Agency A: If your agency serves participants in Muskegon, Oceana, and Ottawa counties, select all three counties.
Agency B: If your agency only serves participants in Ottawa county, select only Ottawa county.

Select One or More Counties Served:*

MuskegonOceanaOttawa

Is this report for Case Coordination & Support?*

YesNo

Service Status Data: Fiscal Year-to-Date (FYTD): All cells must have an amount entered. Enter "0" for none.*

	Muskegon	Oceana	Ottawa
Number of Units Served:
Number of Unduplicated Participants:
African American/Black
American Indian/Eckimo-Aleut
Asian
Native Hawaiian/Other Pacific Islander
Hispanic Origin
Non-Minority
Total Greatest Economic Need (GEN):
Minority Economic Need:
Rural Participants (Oceana County Only):

Service Status Data: Fiscal Year-to-Date (FYTD): All cells must have an amount entered. Enter "0" for none.*

	Muskegon
Number of Units Served:
Number of Unduplicated Participants:
African American/Black
American Indian/Eckimo-Aleut
Asian
Native Hawaiian/Other Pacific Islander
Hispanic Origin
Non-Minority
Total Greatest Economic Need (GEN):
Minority Economic Need:
Rural Participants (Oceana County Only):

Service Status Data: Fiscal Year-to-Date (FYTD): All cells must have an amount entered. Enter "0" for none.*

	Oceana
Number of Units Served:
Number of Unduplicated Participants:
African American/Black
American Indian/Eckimo-Aleut
Asian
Native Hawaiian/Other Pacific Islander
Hispanic Origin
Non-Minority
Total Greatest Economic Need (GEN):
Minority Economic Need:
Rural Participants (Oceana County Only):

Service Status Data: Fiscal Year-to-Date (FYTD): All cells must have an amount entered. Enter "0" for none.*

	Ottawa
Number of Units Served:
Number of Unduplicated Participants:
African American/Black
American Indian/Eckimo-Aleut
Asian
Native Hawaiian/Other Pacific Islander
Hispanic Origin
Non-Minority
Total Greatest Economic Need (GEN):
Minority Economic Need:
Rural Participants (Oceana County Only):

Total Units:

Total of Unduplicated Participants

Total Minorities:

Total GEN:

Upload the Waiting List Report here:

What program or administrative changes have occurred that may affect contracted services? Please provide details such as changes in staffing, contact information, agency or program name, address, phone number, fax number, federal ID number, or any other relevant information (optional):

Please describe any significant successes or challenges encountered in delivering services during the past quarter (optional):

Additional Comments (optional):

Signature*

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