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Emergency Housing Survey
Emergency Housing Survey
Step
1
of
3
33%
Name
First
Last
Email
Name of facility/type of service:
*
Facility Phone Number
How many beds do you have:
What geographic area do you serve:
All of PEI
Eastern Kings
Southern Kings
Charlottetown
Queens
Summerside
West Prince
East Prince
What Population Do You Serve?
Male Adult
Yes
No
Only in certain conditions
Please explain the conditions (Male Adult)
Female Adult
Yes
No
Only in certain conditions
Please explain the conditions (Female Adult)
Male With Children
Yes
No
Only in certain conditions
Please explain the conditions (Male With Children)
Female With Children
Yes
No
Only in certain conditions
Please explain the conditions (Female With Children)
Family
Yes
No
Only in certain conditions
Please explain the conditions (Family)
Female Youth
Yes
No
Only in certain conditions
Please explain the conditions (Female Youth)
Male Youth
Yes
No
Only in certain conditions
Please explain the conditions (Male Youth)
Female Senior
Yes
No
Only in certain conditions
Please explain the conditions (Female Senior)
Male Senior
Yes
No
Only in certain conditions
Please explain the conditions (Male Senior)
Gender X
Yes
No
Only in certain conditions
Please explain the conditions (Gender X)
Youth Pregnant or Parenting
Yes
No
Only in certain conditions
Please explain the conditions (Youth Pregnant or Parenting)
Newcomer
Yes
No
Only in certain conditions
Please explain the conditions (Newcomer)
Do you provide shelter for those fleeting family violence?
Men
Women
Men With Children
Women With Children
Youth
Is your facility accessible for persons with physical disabilities
Yes
No
Do you serve persons with developmental disabilities?
Yes
No
Do you serve persons with mental health/addiction issues?
Yes
No
Do you serve persons with addictions who are actively using?
Yes
No
Do you serve persons who are involved with the criminal justice system or have been recently released from custody or incarceration?
Yes
No
How long can someone stay at your facility?
If your facility is full, where do you refer people to?
Under what conditions?
Any other information you would like to share about your facility/service?
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