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E}:HI;3IT A <br />REPORT FORM E <br />- SUPPORTIVE SERVICES ONLY <br />Activity Name: <br />Activity Location: <br />Persons With HtV/AfDS <br />Other Persons in Family Unit <br />. Total <br />Supportive Services <br />1. Outreach <br />2. Case Management! Advocacy/Access #o Benefits Svcs <br />3. Life Management (outside of Case Management <br />4. Nutritional ServiceslMeals <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. A~ohol and Drub Abuse Services <br />10. Mental Health Services <br />11. HeaithlMedicaUlntensive Care Services <br />12. Permanent Housing Placement <br />13. Emergency Housing <br />14. Transitional Shelter <br />15. Other <br />TOTAL <br />Receiving Supportive Svcs Receiving Supportive Svcs <br />w/ Housing Assistance Onfy <br />^ Number of Jobs that Result from # 7 8 8 <br />HOPWA EXPENDITURES (in dollars) <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 io date: <br />Source of Non-NOPWA Funds <br />Total Non-HOPWA Funds <br />i-10PWA Report Fo!m E <br />Expended # of Persons Served <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 />S <br />S <br />S <br />S <br />+~ <br />=a <br />-S <br />~. <br />Total Available <br /> ,~ <br /> <br /> <br /> <br /> <br /> <br /> sof a <br />Expended To Date <br />S <br />S <br />S <br />1'1!'i204 <br />