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E};HIBIT A <br />REPORT FORM E <br />SUPPORTIVE SERVICES ONLY <br />Activity Name: <br />Activity Location: <br />Persons tN'rth HIV/AIDS <br />Other Persons in Family Unit <br />.Total <br />Receiving Supportive Svcs <br />w/ Housing Assistance <br />Supportive Services <br />1. Outreach <br />2. Case Management/ Advocacy/Access io Benefits Svcs <br />3. Life Management (outside of Case Management <br />4. Nutritional Services/Meals <br />5. Adult Daycare and Personal Assistance <br />t% Chid Care and other Ch~dren's Services <br />7. Education <br />8. Empbyment Assistance <br />9. Akolwl and Drub Abuse Services <br />10. Mental Health Services <br />11. HeatthMledicaVlntensive Care Services <br />12. Permanent Housing Placement <br />i3. Emergency Housing <br />14. Transitions! Shelter <br />15. Other <br />TOTAL <br />^ Number of Jobs that Result from # 7 8 8 <br />HOPWA EXPENDITURES (in doNars) <br />Allocated HOPWA Funds: <br />Allocated HOPWA Program Income: <br />Total HOPWA funds for Project: <br />Total HOPWA Expended to date: <br />Balance HOPWA Funds to date: <br />Source of Non-HOPWA Funds <br />Total Non-HOPWA Funds <br />HOP'WA Report FoRn E <br />Expended To Date <br />3 <br />11/12>'09 <br />Receiving Supportive Svcs <br />Expended ~ of Persons Served <br />~ - <br />S <br />S <br />S <br />S~ <br />s <br />S <br />S <br />S <br />S <br />S <br />S <br />S <br />S <br />+; <br />=S <br />-S <br />=S <br />Total Available <br />~_ _ - <br />S <br />25G-27 <br />sofa <br />