Ryan White Program
Part A
Quarterly Report 2016 - 2017
Reporting Quarter:
Name of Reporting Agency:
________________________________________________
___
Mar. - May
___
June - Aug.
Person completing Report:
___
Sept. - Nov.
________________________________________________
___
Dec. - Feb.
Narrative Questions:
1. New care points of entry added or subtracted during the quarter.
2. Challenges encountered during the quarter and actions taken to address those
difficulties.
3. Positive events including achievements in meeting goals and objectives/new
initiatives to achieve goals/objectives undertaken.
4. Changes to goals and objectives.
5. Changes to program operations (including staff changes).
6. List below the number of unduplicated clients served and the number of units
provided for each quarter.
7. Is the agency keeping up the “Targeted Monthly Expenditures”? Are they over
or under expended? Explain budget categories over or under expended by 10%
or more.
1st Qtr
2nd Qtr
3rd Qtr
4th Qtr
# of unduplicated
clients
# of units
provided
8. TA/Consultation needs identified/addressed.
9. Any comments or suggestions for the Ryan White Program Team.
******Due the 15th of the next month, after the qtr ends. ******
June, Sept., Dec., Mar.
Total