Quarterly Program Report

INSTRUCTIONS

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FY26-27 (7/1/26 - 6/30/27)

1st Quarter Report Due

October 5th, 2026

2nd Quarter Report Due

January 4th, 2027

3rd Quarter Report Due

April 5th, 2027

4th Quarter Report Due

July 5th, 2027

*** Incomplete applications will not be accepted. Do not leave any blanks; enter N/A if not applicable.

AGENCY INFORMATION

Agency Information

Agency Name

Date

Executive Director

Name of Person Filing This Report

Name/Title/Address of person who will receive payment

Please select a quarter

First Quarter

Second Quarter

Third Quarter

Fourth Quarter

Please select teh quarter for which you are reporting for.

AGENCY

EXPLANATION OF UNITS OF SERVICE

Explanation of Units of Service

Please provide an explanation of how you measure units of service.

UNITS OF SERVICE

Units of Service

Units of service delivered

Number of people served by units of service

Unduplicated count of people served

We are looking for specific data relevant to Clinton County ONLY

Location of clients served by the program

Please list the number of clients served by this program.

Please make sure to use UNDUPLICATED numbers

Location of Clients Served by the Program

Lock Haven Area

Renovo Area

Avis/Jersey Shore Area

Mill Hall Area

Lamar Area

Beech Creek Area

Loganton Area

Location Unknown

Age of clients served by the program

Age of Clients Served by the Program

Birth - 6 years

Ages 7 - 18

Ages 19 -25

Ages 26 - 55

Ages 55 and above

Age Unknown

SEX OF CLIENTS SERVED BY THE PROGRAM

Sex of Clients served by the Program

Male

Female

Sex Unknown

HOUSEHOLD INCOME LEVELS OF CLIENTS SERVED BY THE PROGRAM

Household Income Levels of Clients Served by the Program

Under $15,000

$15,000 - $25,000

$25,000 - $35,000

$35,000 - $45,000

Above $45,000

Income Unknown

VOLUNTEER UTILIZATION

Volunteer Utilization

Number of volunteers used in the program

Number of volunteer hours

PROGRAM/AGENCY NEWS

Program/Agency News

Describe anything that happened at your agency that we may need to know.

i.e. successes or setbacks, the introduction or elimination of programs or services, fundraising activities, staff changes, budget issues, etc.

CONDITIONS

Conditions

If there are any conditions on your funding, please tell us how you have worked to meet these conditions

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