Boys & Girls Monthly Reporting Form

Monthly reporting form

The information submitted in this form will be transmitted to the administration of the SBFDC. This information is reviewed and later aggregate to the information previously provided by the B&G staff, compiled with the the information provided by the other collaborating partners from the SBFDC and later presented to the Board of Directors. The information is needed by the Monday before the first Thursday of the month.

If the B&G reporting needs change, or if you have any questions about the information please contact us @ 713-996-8781 or via e-mail.

First Name *	Last Name *
e-mail *	Phone *
Agency	Month reporting for

* These are required fields

Number of members enrolled at the end of the month for which you are reporting, since January	*
Number of volunteers this month	How many hours did the volunteers work?
Number of Club Monitors this month	How many hours did the Club Monitors work?
Number of Community Service workers this month	How many hours did the Community Service workers work?
Number of Adult WorkSource staff this month	How many hours did the Adult WorkSource staff work?
Number of Youth WorkSource staff this month	How many hours did the Youth WorkSource staff work?

Starting in 2004 we are tracking how clients are referred from one provider to another when appropriate. In order to have a better understanding of this dynamic please complete the following information.

From collaborating partners from SBFDC

Received client referrals from

From external sources

Received referrals from

Referrals made to collaborating partners from SBFDC

Made client referrals to

Referrals made to external sources

Made referrals to

Did the club have any special events during reporting month?	Yes No
If you had any special events, could you tell us something about the event(s)
Are you planning any special events?	Yes No
Comments about upcoming special events

Thank you very much for your time and information provided.