[Blank monthly service report] Page: 3 of 6
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Number of
NEW Clients
This Month
Who Have:
D. A Housing Situation Best
Described as
1. Living alone ___
2. Living with parents/
brother/sister/other
relative____
3. Living with spouse/
roommates/significant
other____
4. Living in cooperative,
independent
housing setting __
5. Living in hospital/
nursing home ___
6. Other:_________
III.
Received Direct Support from Your
Agency through
Clothing Donations &
diapers ___
Emotional Support/Counseling ___
Financial Support ___
Food Donations____
Homemaker/Companion Programs ___
Housing Support ___
Legal Counseling ___
Medical/Dental Care ___
Nursing Care____
Pastoral Care ___
Respite/Day Care ___
Substance Abuse Counseling ___
Transportation
Other:____________
IV.
Number of Salaried Staff Involved in Providing
Serviced to Clients this Month
Number of Volunteers Involved in Providing
Services to Clients this Month
Number of Family Members/Significant Others
also Receiving Agency Services this Month
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AIDS ARMS Network, Inc. [Blank monthly service report], text, August 31, 1989; (https://texashistory.unt.edu/ark:/67531/metadc1823373/m1/3/: accessed July 1, 2024), University of North Texas Libraries, The Portal to Texas History, https://texashistory.unt.edu.; crediting UNT Libraries Special Collections.