Garrett County Partnership for Children and Families, Inc. |
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GC PCF HOME |
QUESTIONS? Call Sue, Sue, Crystal or Lucia at 301-334-1189 |
Garrett County LMB ONLINE Community
Information File
SAMPLE DATA ENTRY FORM
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| Program Name | Same as "Organization Name" in some cases |
| Program ID | This is an auto number field. New program entries will automatically be assigned a unique Program ID - also referred to as "Record ID" |
| Organization Name | Name of Organization. Use "GC" for "Garrett County" for keyword searches. |
| Alternate Name | Acronym, or common name - use a comma to separate multiple responses |
| Type of Organization | SEE DROP DOWN LIST |
| Mailing Address | Street: |
| City: | State: | Zip: |
| Physical Address | Street: | 911 address. Fill in only if different from from mailing address. |
| (If different from mailing address) | City:"(same as mailing address)" | State: | Zip: |
| Location of Outreach Services (Branch/Field Operations) | Location of alternate service locations. Where are your services delivered in the community? Example: "Services are provided in the customer's home." (Enter directions to your main office location in the "Transportation & Travel Info" field.) |
| Contact Name | list "staff" if no specific contact |
| Title: |
| Phone: | Extension: |
| Fax: |
| Toll-Free or Other Phone: | TTD or TTY Number: |
| E-Mail: |
| Web Page Address Enter the entire URL beginning with "http://" |
| Hours of Operation | Specify days and hours of service. Example "M-F 8AM-4PM or "24 hours, 7 days a week" |
| Membership Meetings | Time and location of regularly scheduled meetings. Please specify if meetings are open to the public. |
| Wheelchair Accessibility | Specify location of wheelchair access to the building (main entrance, side of building, etc.), availability of handicapped accessible rest room facilities, etc. |
| Accommodations for Disabled | List all available accommodations, contact info., etc. Example: "Accommodations available, call in advance with specific request." |
| Description of Services | Detailed description of services offered. Many of the program descriptions begin with a brief mission statement.(This field can hold more than the default value of 256 characters.) |
| Eligibility |
| Target Group | Use general categories like "Children," "Families," or "Parents," or descriptors referencing income levels, special circumstances or other targeted considerations. See the United Way "Keywords by Category" list for examples of target groups. May overlap with the "ages served" field. |
| Ages Served | SEE DROP DOWN LIST - or specify |
| Geographic Area | Specify geographic area served. State, county, or jurisdictional unit. Example: "Serves Garrett County, MD and nearby areas in PA and WV." |
| Referral/Admission Procedures | Describe how to access services. Example: "Self-referral by phone, walk-ins okay, physician referral, other agency or person." OR "Call to schedule an appointment." |
| Documents Required | What documents do you need to bring with you? What is needed for proof of income or residency? Can an application be completed ahead of time, etc.? |
| Income Guidelines | Give specific examples or use "N/A" - as appropriate. If there is a sliding fee scale, give examples based on family size and income. The more detail, the better. |
| Fees | Specify or give examples of your sliding fee scale. Use "None" if no fees. |
| Wait Time/List | How long do you have to wait for services? Is there a wait list? Use "No" if not. |
| Languages Spoken | "English" is the default. |
| Transportation and Travel Information | Transportation arrangements, public transit, parking. For directions to your office include well-known landmarks. Example: "Consumer transports self, provider visits the home or GTS will transport for a small fee. DSS offices are located on Rt. 219 North of Oakland next to Shaffer Ford." |
| Volunteers | Volunteers Needed | Check if "Yes" (will read "CHECKED" for program record) |
| Volunteer Skills Needed | Describe what you need volunteers to do. Give specific examples. |
| Volunteers Provided | Check if "Yes" (will read "CHECKED" for program record) |
| Volunteer Skills Provided | If your program provides volunteers, what can they do? |
| Publications | Do you have a brochure or newsletter, etc. available? List frequency of distribution. |
| Events | List special or annual events. Only list one-time events if you will be updating your program entry on a regular basis. Example: "Big Brothers/Big Sisters hosts a Bowl for Kids Sake fund raiser every spring. Call for details." |
| Other | Any other pertinent information. If there is a second contact person include their name and phone number here. |
| Primary Service Category | Refer to the list of SERVICE CATEGORIES. |
| Service Locator | List all relevant service categories, include the 'primary service category.' Use commas to separate terms. The utility of this field may be enhanced by using the list of over 700 keywords developed by the United Way of Central MD for their First Call for Help database. |
| Date
Data Entered:
Date program is FIRST added to the database. Use 4 digits for the yr. |
10/03/1998 | Person Entering Data: Name of Registered User | First & Last Name | Tracking
see Tracking Codes list. |
| Date
Data Verified:
Date hard copy of program record is signed. |
10/13/1998 | Date Record Updated: Date record is modified/updated. | 12/03/1998 | ID#: | Unique Identifier | B=completed entry waiting on sig. for verification |
| Signature: Verifies accuracy and permission to publish online | Date Signed |