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EXHIBITA <br />REPORT FORM E <br />SUPPORTIVE SERVICES <br />Program: <br />Location: <br />Receiving Supportive Svcs <br />wl Housing Assistance <br />Persons With HIV/AIDS <br />Other Persons in Family Unit <br />Total <br />Receiving Supportive Svcs <br />Only <br />Supportive Services $ Expended <br />1. Outreach $ <br />2. Case Management/ Advocacy/Access to B enefits Svcs $ <br />3. Life Management (outside of Case Management $ <br />4. Nutritional Services/Meals $ <br />5. Adult Day care and Personal Assistance $ <br />6. Child Care and other Children's Services $ <br />7. Education * $ <br />8. Employment Assistance " $ <br />9. Alcohol and Drub Abuse Services $ <br />10. Mental Health Services $ <br />11. Health/Medical/Intensive Care Services $ <br />12. Permanent Housing Placement $ <br />13. Transitional Shelter $ <br />14. Other $ <br />15. Other $ <br /> TOTAL $ <br />^ Number ofJobs /New Employment that Result from # 7 & 8 <br />Available HOPWA Funds: <br />Total HOPWA Funds for Project: $ <br />Total HOPWA Expended To Date: $ <br />Project Balance Remaining: $ <br />Leveraging (for year end report only): <br />Non-HOPWA Funds: $ <br /> <br />Value of In-Kind Support: $ <br /> <br />Total of Leveraged Amounts: $ <br />Page 5 of 6 <br />25E-25 <br /># of Persons Served <br />Revised 05/05/09 <br />