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ORGANIZATION INFORMATION SECTION (pages 2 - 8) <br /> ORGANIZATION PROFILE <br /> DIVIDER SHEET <br /> ORGANIZATION NAME: Kota. AdiI.1 r nay ranter IPC_ Page #2 <br /> A. AGENCY PROFILE: (Answer on separate paper and attach to this divider sheet.) <br /> 1. Agency Name: <br /> Geographic Area(s) Served: <br /> Agency's Mission Statement: <br /> 2. Briefly describe the kinds of programs and services the agency provides. <br /> 3, How do these services support the agency's mission? <br /> 4. Who is eligible for services? <br /> 5. Provide an unduplicated count of the number of individuals served by the agency? <br /> List by program title. <br /> 6. What are the specific objectives of the agency (in quantitative terms, where possible)? <br /> 7. How do you evaluate programs/services effectiveness, and who does the evaluation? <br /> 8. What other resources or providers do you coordinate with to deliver agency services? <br /> Do you contract with these resources or providers? <br /> 9. How does this agency's services/programs vary from similar services/programs offered <br /> by other agencies in the community? <br /> 10. List specific accomplishments or challenges addressed by the agency this last year. <br /> 11. Does the agency have membership dues? If so, list current rates by category(adult, <br /> youth, honorary, etc...). <br /> 12. Does the agency have a trade affiliation with a national or statewide organization? If so, <br /> what is the formula for national and/or state contributions and how often are dues paid? <br /> 13. What benefits and/or services are provided to the agency by the national or statewide <br /> organization? <br />