Q4 - FY24.25 FRHD Community Health Contract Grant Impact Report

1

Organization Information* This field is required.Please provide the legal name of the organization, as it appears on your 990. If you have a different DBA or nickname please add that in the box adjacent to the legal name.

Legal Name

DBA (if Applicable)

2

Contact Information* This field is required.Please add the contact information for the person responsible for the submission and monitoring of this grant application.

Contact Name

Title

Primary Contact Phone

Email Address

3

Organization Physical Address* This field is required.This is the primary address where the Organization provides services.

Street Address

Street Address Line 2

City

State / Province

Postal / Zip Code

Country

4

Program Name/Title* This field is required.

5

Describe the impact of the program to date. Briefly explain how the service/intervention has worked - include cumulative metrics from approved application.* This field is required.Please limit your response to 250 words.

0/250

6

Number of residents that directly benefitted (participant/client) from this program.* This field is required.The number of residents that receive the service or who are enrolled in your program.

7

Target Population - Age* This field is required.List the percentages of your program participants’ ages. Percentages must add up to 100%

Percent of program participants

Estimated number of participants

Children (infants to 12)

Young Adults (13-17)

Adults (18-60)

Seniors (60+)

We do not collect this data (indicate with 100%)*

Children (infants to 12)

Young Adults (13-17)

Adults (18-60)

Seniors (60+)

We do not collect this data (indicate with 100%)*

Percent of program participants

Estimated number of participants

Percent of program participants

Estimated number of participants

Percent of program participants

Estimated number of participants

Percent of program participants

Estimated number of participants

Percent of program participants

Estimated number of participants

8

Target Population not collected - Age* This field is required.If you indicated that you do not collect data on the above question, please provide a rationale as to why that information is not sought. Write NA if this question does not apply to your organization

0/200

9

Target Population - Gender* This field is required.List the percentages of your program participants’ gender identification. Percentages must add up to 100%

Percent of program participants

Female

Male

Non-binary

Unknown*

Female

Male

Non-binary

Unknown*

Percent of program participants

10

*Target Population - Gender* This field is required.If you indicated that you do not collect data on the above question, please provide a rationale as to why that information is not sought. Write NA if this question does not apply to your organization

0/200

11

Target Population - Income Level* This field is required.List the percentages of your program participants' income limit category - 2012 HUD – AMI Income limits (4 person family). Percentages must add up to 100%

Percent of program participants

Extremely Low-Income Limits, ceiling of $32,100

Very Low (50%) Income Limits, ceiling of $53,500

Low (80%) Income Limits, ceiling of $85,600

Higher Than Listed Limits

We do not collect this data (indicate with 100%)*

Extremely Low-Income Limits, ceiling of $32,100

Very Low (50%) Income Limits, ceiling of $53,500

Low (80%) Income Limits, ceiling of $85,600

Higher Than Listed Limits

We do not collect this data (indicate with 100%)*

Percent of program participants

12

*Target Population - Income Level* This field is required.If you indicated that you do not collect data on the above question, please provide a rationale as to why that information is not sought. Write NA if this question does not apply to your organization

0/300

13

What language(s) does this program accommodate:* This field is required.Where most or the at least half of the program can be provided in the participant's primary language.

English

Spanish

Tagalog

Chinese (Mandarin/Cantonese)

Other

14

What demographic group does this program predominately serve:* This field is required.Select the one category that best describes your program's participants

Youth - school based

Older Adults

Youth - other setting

Special Populations

Community - Health & Fitness

15

Program/Services Description - Social Determinants of Health* This field is required.Please select the following SDOH your program directly addresses. Please select only those that your goals and objectives will demonstrate a measurable outcome.

Economic Stability (Employment, Food Insecurity, Housing Instability, Poverty)

Education Access & Quality (Early Childhood Education and Development, Enrollment in Higher Education, High School Graduation, Language and Literacy)

Social & Community Context (Civic Participation, Discrimination, Incarceration, Social Cohesion)

Healthcare Access & Quality (Access to Health Care, Access to Primary Care, Health Literacy)

Neighborhood & Built Environment (Access to Foods that Support Healthy Eating Patterns, Crime and Violence, Environmental Conditions, Quality of Housing)

16

Program Goal* This field is required.What is the program goal? Be clear in defining how the goal(s) relate to how the program addresses the need. Please outline the goal(s) utilizing the SMART methodology.

0/150

17

Program Objectives & Measurable Outcomes* This field is required.Please describe the objectives of how this program will meet its goal - as outlined above. Be clear in defining how each objective serves the goal. Keep in mind that your objectives should be specific and concise - provides the “who” and “what” of program activities. Defines the "what" that will be measured and the "how" of the outcomes as it relates to the provision of the program. What quantitative information will you be gathering and reporting as it relates to the impact of your program's services. Explain how the success of the program’s interventions or services for each objective will be measured.

0/1000

18

District Support Acknowledgment* This field is required.Please select the methods by which the Organization acknowledged the District's investment of funding.

Social Media Postings

Signage at Service Sites

Print Materials to Service Recipients

Website Display

Other

19

District Support AcknowledgmentPlease upload an example of how the District's support for this service/program was acknowledged during this quarter.

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Max. file size: 10.6MB

20

Program Budget* This field is required.Please upload the Program Budget & Narrative file. Use the District provided spreadsheet that was submitted with the application. Fill in only the section for this corresponding quarter.

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Max. file size: 10.6MB

21

Confirmation* This field is required.By selecting Yes, you are confirming that the data submitted is accurate.

YES - this information is accurateNO - this information may not be complete or may be inaccuare