Kids Cafe Monthly Report

Site Name:

Agency #:

(must enter correctly)
Today's Date: (Enter mm/dd/yyyy; Example 01/30/2006)
Report Month: (Remember, select last month -- when services were delivered)
Report Year: (Enter yyyy; Example 2006)
Did You Have A Health Department Visit This Month?
 
SERVICE
Total Number of Meals Served:
Total Number of Snacks Served:
Days Open This Month:
Hours open each day
Days open each week
Weeks open this month
Total Number of Children Attending: A  (count every child who attended this month; do not record monthly attendance)

               Ex. Jimmy attended 5 days, Jackie attended 6 days, Justin attended 3 days

                     Total Number of Children Attending = 3 (Jimmy, Jackie, and Justin)

Number of NEW Children THIS Month:

Ages of Children Attending This Month:

B + C + D + E + F should equal A

0 to 4

 B
5 to 10 C
11 to 15 D
16 to 18 E
over 18 but still in high school F

Racial/Ethnic Background of Children Attending This Month:

G + H + I + J + K + L + M should equal A
African-American G
Asian H
Caucasian I
American Indian/Alaskan Native J
Native Hawaiian/Pacific Islander K
Other L
Latino/Hispanic M
 Did You Operate a Backpack Program?

Number of Days Backpacks Sent Home:

 (Example: If you sent home backpacks every Friday this month, enter 4)

Total Number of Backpacks Filled:

 (Example: 14 packs Week 1 + 12 packs Week 2 + 0 packs Weeks 3 and 4 = 26 packs)

Total Number of Children with a Backpack:

 (count every child who took home a backpack this month)
  
SUPPORT UNPAID STAFF are regular helpers who play vital roles in the operation of your program but do not get paid. At some sites, the director is unpaid. This person would be considered an UNPAID STAFF member. However someone who occasionally volunteers to help with homework (and does not get paid) would be considered a VOLUNTEER.
Staff (including site director)
Total Number of Paid Staff:  
    Number of paid staff who are parents of participating children      
Total Number of Unpaid Staff:  
    Number of unpaid staff who are parents of participating children  
Volunteers
Total Number of One-Time or Occasional Volunteers: (do not include unpaid staff)
    Number of volunteers who are parents of participating children    
 
ACTIVITIES
Planned Educational Activities: Health    How Many Events? Total Number of Parents Attending
(check all that apply) Hygiene  How Many Events? Total Number of Parents Attending
Nutrition  How Many Events? Total Number of Parents Attending
Job Training  How Many Events? Total Number of Parents Attending
Food Preparation  How Many Events? Total Number of Parents Attending
Life Skills  How Many Events? Total Number of Parents Attending
Community Service  How Many Events? Total Number of Parents Attending
Other Total Number of Parents Attending
Other Total Number of Parents Attending
 
Special Activities: Number of Parents Attending
Number of Parents Attending
Number of Parents Attending
Number of Parents Attending
 
Regular Activities: Arts and Crafts Computer
(check all that apply) Homework Assistance Religion
Game room Recreation
Gardening Mentoring
Tutoring Socialization
Other Other
 
Please describe any problems or needs:

5 lines maximum
 
We would love to learn about any stories of how your program is making a real difference in the lives of the children you serve!

5 lines maximum
 
Any other information you want to share that was not requested on the form:

5 lines maximum

 

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