Family & Support Services
Human Services Delivery
Scope of Services
Grantee:
Service Area:
Term of contract: January 1, 2016 - December 31, 2016
Contract amount:
Grantee contact person for this contract
Name:
Phone Number:
E-Mail:
Mailing Address:
Number of staff positions supported by this contract
Full-time
Part-time
Number of new staff positions created by this contract
Full-time
Part-time
Listing of positions supported by this contract:
Percent of time
Title
dedicated to Project
Services to be provided clients by position titles listed above:
1
Agency (list either grantee agency,
or name of subgranted agency where
position is employed)
Family & Support Services
Human Services Delivery
Scope of Services
Required Services
#Clients
#Households
Total unduplicated number of clients and households to be
served
1. Client Screening
# of clients screened
# of clients screened that receive services/benefits
Process for screening clients for services/benefits and assisting them in applying for services/benefits
2. Outreach and Engagement
Number of Events
Conducted
Outreach Methods
Direct outreach
The agency is required to comply with all Program Guidelines as outlined by DFSS.
2
Family & Support Services
Human Services Delivery
Scope of Services
Submittal and approval:
a) Applicant signature:
b) Name (typed)
c) Date submitted:
d) DFSS Staff signature :
e) Name (typed):
f) Date approved
3
Joel R. Mitchell