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s <br /> ~ I <br /> - REPORT FORNt E <br /> SUPPORTIVE SERVICES <br /> Program: ~ <br /> Location: <br /> Receiving Supportive Svcs Receiving Supportive Svcs <br /> w/ l-lousing Assistance Oniy ~ <br /> Persons With HfV/AIDS <br /> Other Persons in Family Unit <br /> Total _ I <br /> Supportive Services $ 1xpended # of Persons Served ~ <br /> 1. Outreach $ <br /> 2. Case Management/ Advocacy/Access to Benefits Svcs $ <br /> 3. Life Management (outside of Case Management <br /> a. - Nutritional ServlceslMeais $ <br /> 5. Adult Day care and Personal Assistance ~ i <br /> <br /> _ 6, Ghiid Care and other Children's Services $ <br /> i <br /> 7. Education' $ <br /> 8. Employment Assistance' $ <br /> 9. Alcohol and Drub Abuse Services $ ~ <br /> 10. Mental Health Services $ <br /> 11. Health/Medicafllntensive Care Services $ <br /> 12. Permanent f-lousing Placement ~ <br /> 13. Transitional Shelter $ <br /> 14. Other $ <br /> 15. Other $ <br /> TOTAL $ <br /> Number of Jobs ! Ne~v Employment that Result from # 7 & 8 - <br /> i <br /> Available HOPWA l=ands: <br /> 4 <br /> Total NOPWA Funds for Project: $ ! <br /> Total HOpWA Expended To Date: $ ' <br /> Project i3alance Remaining: $ f~ <br /> I <br /> 1 <br /> Leveraging (#or year end report only}: k <br /> 1 <br /> Non-NOPWA Funds: $ <br /> Value of In-Kind Support: $ <br /> Total of Leveraged Amounts: $ <br /> i <br /> Revised 05!05109 <br /> i <br /> 25D-28 ~ <br /> <br />