Unified Community Resource Collaboration (UCRC)
On behalf of the City of Leduc we thank you for taking 20-30 minutes to fill out this online questionnaire. Please be as thorough as possible when filling out below information.
Organization Info
Name of person filling out questionnaire
name of staff member
Email address of person filling out questionnaire
email of staff member
Name of Organization
Please list the names/roles of your senior/executive staff
Please list the names/roles of your front-line staff
Organization's Hours of Operation
Include emergency and after hours options
Any Restriction on Clients you are not able to work with?
Client Information
Demographic of Clients your Organization Works with.
Gender of Clients Served
Male
Female
LGBTQ+
Age Range
12 - 17
18 -24
25 - 34
35 - 44
45 - 54
55 - 64
65 - 74
75+
Does the organization work with a specific ethnic demographic?
if so please list
Do your client receive income from a specific source?
If so please list
Do you works with clients of a specific education level?
if so please list
Does you organization work within a specific service are with the County of Leduc?
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Program/Service Types
Select one or more of the services that are offered within your organization.
Financial Support
Income Navigation
Benefit Application
Subsidies
Budgeting
Employment Support
Financial Literacy
Other
Format of Programs Offered
One on One
Group Setting Gender Specific
Group Setting Gender Mixed
Crisis Intervention
Counselling
Outreach
Appointment Based
Walk in
What is the frequency of program(s) being offered?
What is the capacity of the program(s) being offered?
What is the cost to the client of the program(s) being offered?
Housing Services
Immediate Shelter
Interim Housing
Long Term Housing
Housing Subsidies
Supportive Living
Home Care
House Hold Goods/Furniture
Landlord Relations
Other
Format of Programs Offered
One on One
Group Setting Gender Specific
Group Setting Gender Mixed
Crisis Intervention
Counselling
Outreach
Appointment Based
Walk in
What is the frequency of program(s) being offered?
What is the capacity of the program(s) being offered?
What is the cost to the client of the program(s) being offered?
Physical Health
Physician Referral
Diagnosis
Prescription and/or Storage of Medication
Support For People with Physical Disabilities
Other
Format of Programs Offered
One on One
Group Setting Gender Specific
Group Setting Gender Mixed
Crisis Intervention
Counselling
Outreach
Appointment Based
Walk in
What is the frequency of program(s) being offered?
What is the capacity of the program(s) being offered?
What is the cost to the client of the program(s) being offered?
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Mental Health and Substance Use
Counselling
Treatment Options
Suicide Support
Crisis Diversion
Practices in Harm Reduction
Wellness/Mindfulness Practices
Trauma Therapy
Other
Format of Programs Offered
One on One
Group Setting Gender Specific
Group Setting Gender Mixed
Crisis Intervention
Counselling
Outreach
Appointment Based
Walk in
What is the frequency of program(s) being offered?
What is the capacity of the program(s) being offered?
What is the cost to the client of the program(s) being offered?
Legal Support
Immigration
Legal Representation
Victim Services/Safety Planning
Offender Support
Court Preparation/Accompaniment
Custody Support
Identification Obtainment
Other
Format of Programs Offered
One on One
Group Setting Gender Specific
Group Setting Gender Mixed
Crisis Intervention
Counselling
Outreach
Appointment Based
Walk in
What is the frequency of program(s) being offered?
What is the capacity of the program(s) being offered?
What is the cost to the client of the program(s) being offered?
Family Services
Parenting Support
Early Learnings and Child Support
Day Care Services
Distribute Family Products
Pregnancy Resources and Support
Other
Format of Programs Offered
One on One
Group Setting Gender Specific
Group Setting Gender Mixed
Crisis Intervention
Counselling
Outreach
Appointment Based
Walk in
What is the frequency of program(s) being offered?
What is the capacity of the program(s) being offered?
What is the cost to the client of the program(s) being offered?
Support Network
Peer to Peer
Mentoring
Support Groups
Cultural Support
Faith Base/Religious Services
Other
Format of Programs Offered
One on One
Group Setting Gender Specific
Group Setting Gender Mixed
Crisis Intervention
Counselling
Outreach
Appointment Based
Walk in
What is the frequency of program(s) being offered?
What is the capacity of the program(s) being offered?
What is the cost to the client of the program(s) being offered?
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Essential Resources
Food
Clothing
Transportation
Other
Format of Programs Offered
One on One
Group Setting Gender Specific
Group Setting Gender Mixed
Crisis Intervention
Counselling
Outreach
Appointment Based
Walk in
What is the frequency of program(s) being offered?
What is the capacity of the program(s) being offered?
What is the cost to the client of the program(s) being offered?
Education/Skill Development
Computers/Technologies Skills
Program Certification
Self-Esteem/Personal Growth Workshops
Daily Living Skills
Other
Format of Programs Offered
One on One
Group Setting Gender Specific
Group Setting Gender Mixed
Crisis Intervention
Counselling
Outreach
Appointment Based
Walk in
What is the frequency of program(s) being offered?
What is the capacity of the program(s) being offered?
What is the cost to the client of the program(s) being offered?
Resource Navigation
Referral and Form Completion Support
Advocacy for Clients
Other
Format of Programs Offered
One on One
Group Setting Gender Specific
Group Setting Gender Mixed
Crisis Intervention
Counselling
Outreach
Appointment Based
Walk in
What is the frequency of program(s) being offered?
What is the capacity of the program(s) being offered?
What is the cost to the client of the program(s) being offered?
Community Participation
Recreation Programs
Sport Supplies
Leisure Activities
Site Tours
Space for Workshops and Programming
Other
Format of Programs Offered
One on One
Group Setting Gender Specific
Group Setting Gender Mixed
Crisis Intervention
Counselling
Outreach
Appointment Based
Walk in
What is the frequency of program(s) being offered?
What is the capacity of the program(s) being offered?
What is the cost to the client of the program(s) being offered?
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Agency Partnerships
Do you raise financial resources or support other groups, programs or other organizations within the area?
Yes
No
Other
If providing referrals, what are the organizations your refer most to?
What is your referral process?
Do any of your programs operate through any established partnerships?
If so, please indicated what the partnerships are?
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Evaluation
How does your agency currently collect information on programs being offered:
Case Management Software
Access/Excel Documentation
Hard Copies
Other
Number of Staff tracking client information?
How does your Agency evaluate effectiveness of the services being offered?
How does your agency evaluate how your services are accessed?
How does your organization identify the need for additional programs?
How does your organization analyze information to improve performance on services being offered?
Has your agency identified the need for improvement in specific areas of service delivery with the Leduc Region?
If so please list.
Has your agency identified areas of successful service delivery with the Leduc Region?
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Attachments
Please upload any examples of your Organizations Intake, Referral, Consent or Past Reports Documents that you would be willing to share.
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Final Remarks
Please let us know of any items that were missed by this questionnaire as well as any feedback with the UCRC initiative.
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