council for life™
ALL DATA SHOULD REFLECT NUMBERS FROM SEPTEMBER 1, 2016 - AUGUST 31, 2017, UNLESS OTHERWISE NOTED BELOW.
FULL LEGAL NAME OF AGENCY
NATURE OF REQUEST (i.e., Sonogram machine, training, staff salaries, etc.)
AMOUNT OF REQUEST
TOTAL PROJECT COST
TOTAL PRIOR YEAR OPERATING BUDGET (2016 Actual)
CURRENT YEAR OPERATING BUDGET (2017 PROJECTED)
NEXT YEAR OPERATING BUDGET (2018 PROJECTED)
NUMBER OF PAID EMPLOYEES (#FT/#PT)
NUMBER OF VOLUNTEERS & NUMBER OF VOLUNTEER HOURS
NUMBER, TYPE, AND AGE OF SONOGRAM MACHINE(S) (i.e., 2D/3D-4D)
DO YOU PROVIDE SERVICES IN SPANISH? IF SO, WHAT PERCENTAGE OF YOUR SERVICES ARE PROVIDED IN SPANISH. IF YOU PROVIDE SERVICES IN ANOTHER LANGUAGE, PLEASE DESCRIBE.
NUMBER OF FACILITIES AND TYPE (i.e., brick & mortar, mobile; for instance, 1 brick & mortar and 2 mobile units)
COUNTY(IES) AND TOP 10 ZIP CODES WHERE YOUR CLIENTS LIVE (This is for all services, not just for this particular project.)
WHAT TYPE OF CLIENT MANAGEMENT SYSTEM DO YOU USE?
IF OTHER, INDICATE HERE:
TOTAL NUMBER OF CLIENTS
TOTAL NUMBER OF CLIENT VISITS (individual clients may come to your center multiple times)
NUMBER OF BABIES SAVED
NUMBER OF CLIENT ABORTIONS (only if known/verified)
NUMBER OF CLIENTS WHO WERE PRESENTED THE GOSPEL OF JESUS CHRIST?
BRIEFLY EXPLAIN YOUR APPROACH TO SHARING THE GOSPEL.
NUMBER OF CLIENTS WHO INDICATED A DECISION TO RECEIVE CHRIST.
INDICATE IF/HOW YOU OFFER ONGOING SPIRITUAL SUPPORT SERVICES OR REFERRALS.
CENTER SERVICES & SUPPORT PROGRAMS
NUMBER OF PREGNANCY TESTS ADMINISTERED
NUMBER OF POSITIVE PREGNANCY TESTS
NUMBER OF CLIENTS WHO HAD AN ULTRASOUND
NUMBER OF ULTRASOUNDS PERFORMED (some clients may have had more than one ultrasound)
NUMBER OF STD TESTS PERFORMED
NUMBER OF POSITIVE STD TESTS
NUMBER OF CLIENTS WHO RECEIVED MATERIAL RESOURCES (i.e., diapers, baby clothes, furniture, etc.)
NUMBER OF CLIENTS RECEIVING PRE-NATAL CARE
NUMBER OF CLIENTS PARTICIPATING IN ONGOING MENTORING/BIBLE STUDY
NUMBER OF ADOPTION REFERRALS MADE
CLIENT INITIAL ASSESSMENTS
NUMBER OF CLIENTS INITIALLY ASSESSED AS ABORTION-MINDED?
The abortion-minded woman is one who appears to be planning or intending to obtain an abortion. Qualified Clinic personnel may recommend and schedule the client for a sonographic examination. CRITERIA: 1. Client is seeking information as to how to obtain an abortion. For example, asking questions such as, “How much does an abortion cost?” Can you give me a referral for an abortion?” “Do you do abortions here?” 2. She has an abortion scheduled, regardless of how tentative she seems. 3. The abortion procedure has been initiated, as in the introduction of laminaria.
NUMBER OF CLIENTS INITIALLY ASSESSED AS ABORTION-VULNERABLE.
The abortion-vulnerable woman is one who by continuing her pregnancy faces obstacles that she may feel incapable of handling or unwilling to experience. This category might also include women who state that they are pro-choice but are uninterested in aborting at this point. The counselor who detects the client’s vulnerability for abortion shares this information with qualified Clinic personnel who will evaluate and may recommend and schedule the client for a sonographic examination. CRITERIA: 1. Client has not eliminated the possibility of abortion. 2. Client lacks support from significant influencers (boyfriend, husband, parents) or is being pressured to have or consider an abortion. 3. Client is undecided. This may be expressed verbally or marked on the intake form. 4. Client is against abortion; however, she has a medical condition she thinks may affect the pregnancy. 5. Client is single (80% of women who abort are single, thus at a higher risk for abortion).
NUMBER OF CLIENTS INITIALLY ASSESSED AS INTENDING TO CARRY TO TERM
This client does not meet criteria for abortion-minded or abortion-vulnerable, but meets the additional criteria noted below. CRITERIA: 1. She does not believe abortion is right. 2. All indications reveal a healthy pregnancy. 3. She has support from all significant influences in her life.
NUMBER OF CLIENTS INITIALLY UNASSESSED
IF YOU HAD UNASSESSED CLIENTS, PLEASE DESCRIBE WHY A CLIENT WOULD FALL INTO THIS CATEGORY?
NAME OF PERSON TO WHOM QUESTIONS REGARDING THIS INFORMATION SHOULD BE DIRECTED
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