Worksheet 6

Community Resources: Service Providers

Ways to Use this Worksheet

  • Use it to document the formal resources in the community.
  • Use it to develop a resource directory which is specific to your community and to assist you in determining where there are gaps and barriers to service. 

 

Agency name: 

 

 

Days and Hours of Operation:

 

Sites of Service Provision: 

 

Address:

 

Telephone/Fax:

 

Mission and Purpose:

 

Description of Core Services Provided:

 

Eligibility Criteria:

 

Cost of services:

 

Summary of Client Population:

 

Funding sources:

 

Other information: