2015 Listing of Services - Non-Federated/Independent

2016-17 State Charitable Contributions Program

Listing of Service Area, Services Provided and Numbers of Clients Served

For Non-Federated Charitable Organizations

Name of Charitable Organization______

Instructions for Completing this Form

Using the numbers assigned to the e service categories listed below, please indicate below which county(s) your organization serves and the number of clients receiving each type of service in each county. For example, if your organization provided adoption services in Clinch and Harris counties to 5 individuals, you would type or print the number 10 under Clinch and Harris counties and indicate in the column provided that 5 individuals received this service in 2014 or 2015. See example below. Use continuation sheet attached if additional space is needed.

EXAMPLE

ClinchCounty
10 – Adoption Services ______/ Number of Clients
Served in 2014 or 2015
______5______
HarrisCounty
10 – Adoption Services
______/ Number of Clients
Served in 2014 or 2015
______5______

Service Categories

1. Service, research and education in the health field

2. Family and child care services

3. Protective services for children and adults

4. Services for children and adults in foster care

5. Services related to the management and maintenance of the home

6. Day care services for adults

7. Transportation services

8. Information, referral and counseling services

9. The preparation and delivery of meals

10. Adoption services

11. Emergency shelter

12. Neighborhood and community organization services

13. Recreation services

14. Social adjustment and rehabilitation services

15. Health support services

16. Animal Health/Welfare Services

17. Services concerned with the ecological impact of altering the environment

18. Services concerned with the cultivation or imparting of knowledge or skills

19. Combination of services to meet the special needs of specific groups, such as children and

youth, the aged, the ill and infirm, and the disabled (Specify)

Appling County
______/ Number of Clients
Served in 2014 or 2015
______
AtkinsonCounty
______/ Number of Clients
Served in 2014 or 2015
______
BaconCounty
______/ Number of Clients
Served in 2014 or 2015
______
BakerCounty
______/ Number of Clients
Served in 2014 or 2015
______
BaldwinCounty
______/ Number of Clients
Served in 2014 or 2015
______
BanksCounty
______/ Number of Clients
Served in 2014 or 2015
______
BarrowCounty
______/ Number of Clients
Served in 2014 or 2015
______
BartowCounty
______/ Number of Clients
Served in 2014 or 2015
______
BenHillCounty
______/ Number of Clients
Served in 2014 or 2015
______
BerrienCounty
______/ Number of Clients
Served in 2014 or 2015
______
BibbCounty
______/ Number of Clients
Served in 2014 or 2015
______
BleckleyCounty
______/ Number of Clients
Served in 2014 or 2015
______
BrantleyCounty
______/ Number of Clients
Served in 2014 or 2015
______
Brooks County
______/ Number of Clients
Served in 2014 or 2015
______
BryanCounty
______/ Number of Clients
Served in 2014 or 2015
______
BullochCounty
______/ Number of Clients
Served in 2014 or 2015
______
BurkeCounty
______/ Number of Clients
Served in 2014 or 2015
______
ButtsCounty
______/ Number of Clients
Served in 2014 or 2015
______
CalhounCounty
______/ Number of Clients
Served in 2014 or 2015
______
CamdenCounty
______/ Number of Clients
Served in 2014 or 2015
______
CandlerCounty
______/ Number of Clients
Served in 2014 or 2015
______
CarrollCounty
______/ Number of Clients
Served in 2014 or 2015
______
CatoosaCounty
______/ Number of Clients
Served in 2014 or 2015
______
CharltonCounty
______/ Number of Clients
Served in 2014 or 2015
______
ChathamCounty
______/ Number of Clients
Served in 2014 or 2015
______
ChattahoocheeCounty
______/ Number of Clients
Served in 2014 or 2015
______
ChattoogaCounty
______/ Number of Clients
Served in 2014 or 2015
______
CherokeeCounty
______/ Number of Clients
Served in 2014 or 2015
______
ClarkeCounty
______/ Number of Clients
Served in 2014 or 2015
______
ClayCounty
______/ Number of Clients Served in 2014 or 2015
______
ClaytonCounty
______/ Number of Clients
Served in 2014 or 2015
______
ClinchCounty
______/ Number of Clients
Served in 2014 or 2015
______
CobbCounty
______/ Number of Clients
Served in 2014 or 2015
______
CoffeeCounty
______/ Number of Clients
Served in 2014 or 2015
______
ColquittCounty
______/ Number of Clients
Served in 2014 or 2015
______
ColumbiaCounty
______/ Number of Clients
Served in 2014 or 2015
______
CookCounty
______/ Number of Clients
Served in 2014 or 2015
______
CowetaCounty
______/ Number of Clients
Served in 2014 or 2015
______
CrawfordCounty
______/ Number of Clients
Served in 2014 or 2015
______
CrispCounty
______/ Number of Clients
Served in 2014 or 2015
______
DadeCounty
______/ Number of Clients
Served in 2014 or 2015
______
DawsonCounty
______/ Number of Clients
Served in 2014 or 2015
______
DecaturCounty
______/ Number of Clients
Served in 2014 or 2015
______
DeKalbCounty
______/ Number of Clients
Served in 2014 or 2015
______
DodgeCounty
______/ Number of Clients
Served in 2014 or 2015
______
Dooly County
______/ Number of Clients
Served in 2014 or 2015
______
DoughertyCounty
______/ Number of Clients
Served in 2014 or 2015
______
Douglas County
______/ Number of Clients
Served in 2014 or 2015
______
Early County
______/ Number of Clients
Served in 2014 or 2015
______
EcholsCounty
______/ Number of Clients
Served in 2014 or 2015
______
EffinghamCounty
______/ Number of Clients
Served in 2014 or 2015
______
ElbertCounty
______/ Number of Clients
Served in 2014 or 2015
______
EmanuelCounty
______/ Number of Clients
Served in 2014 or 2015
______
EvansCounty
______/ Number of Clients
Served in 2014 or 2015
______
Fannin County
______/ Number of Clients
Served in 2014 or 2015
______
FayetteCounty
______/ Number of Clients
Served in 2014 or 2015
______
FloydCounty
______/ Number of Clients
Served in 2014 or 2015
______
ForsythCounty
______/ Number of Clients
Served in 2014 or 2015
______
FranklinCounty
______/ Number of Clients
Served in 2014 or 2015
______
FultonCounty
______/ Number of Clients
Served in 2014 or 2015
______
GilmerCounty
______/ Number of Clients
Served in 2014 or 2015
______
GlascockCounty
______/ Number of Clients
Served in 2014 or 2015
______
Glynn County
______/ Number of Clients
Served in 2014 or 2015
______
GordonCounty
______/ Number of Clients
Served in 2014 or 2015
______
Grady County
______/ Number of Clients
Served in 2014 or 2015
______
GreeneCounty
______/ Number of Clients
Served in 2014 or 2015
______
GwinnettCounty
______/ Number of Clients
Served in 2014 or 2015
______
HabershamCounty
______/ Number of Clients
Served in 2014 or 2015
______
HallCounty
______/ Number of Clients
Served in 2014 or 2015
______
HancockCounty
______/ Number of Clients
Served in 2014 or 2015
______
Haralson County
______/ Number of Clients
Served in 2014 or 2015
______
HarrisCounty
______/ Number of Clients
Served in 2014 or 2015
______
HartCounty
______/ Number of Clients
Served in 2014 or 2015
______
Heard County
______/ Number of Clients
Served in 2014 or 2015
______
HenryCounty
______/ Number of Clients
Served in 2014 or 2015
______
HoustonCounty
______/ Number of Clients
Served in 2014 or 2015
______
IrwinCounty
______/ Number of Clients Served in 2014 or 2015
______
JacksonCounty
______/ Number of Clients
Served in 2014 or 2015
______
Jasper County
______/ Number of Clients
Served in 2014 or 2015
______
JeffDavisCounty
______/ Number of Clients
Served in 2014 or 2015
______
JeffersonCounty
______/ Number of Clients
Served in 2014 or 2015
______
JenkinsCounty
______/ Number of Clients
Served in 2014 or 2015
______
JohnsonCounty
______/ Number of Clients
Served in 2014 or 2015
______
JonesCounty
______/ Number of Clients
Served in 2014 or 2015
______
LamarCounty
______/ Number of Clients
Served in 2014 or 2015
______
LanierCounty
______/ Number of Clients
Served in 2014 or 2015
______
Laurens County
______/ Number of Clients
Served in 2014 or 2015
______
LeeCounty
______/ Number of Clients
Served in 2014 or 2015
______
LibertyCounty
______/ Number of Clients
Served in 2014 or 2015
______
LincolnCounty
______/ Number of Clients
Served in 2014 or 2015
______
LongCounty
______/ Number of Clients
Served in 2014 or 2015
______
LowndesCounty
______/ Number of Clients
Served in 2014 or 2015
______
LumpkinCounty
______/ Number of Clients
Served in 2014 or 2015
______
MaconCounty
______/ Number of Clients
Served in 2014 or 2015
______
Madison County
______/ Number of Clients
Served in 2014 or 2015
______
MarionCounty
______/ Number of Clients
Served in 2014 or 2015
______
McDuffieCounty
______/ Number of Clients
Served in 2014 or 2015
______
McIntoshCounty
______/ Number of Clients
Served in 2014 or 2015
______
MeriwetherCounty
______/ Number of Clients
Served in 2014 or 2015
______
MillerCounty
______/ Number of Clients
Served in 2014 or 2015
______
MitchellCounty
______/ Number of Clients
Served in 2014 or 2015
______
MonroeCounty
______/ Number of Clients
Served in 2014 or 2015
______
Montgomery County
______/ Number of Clients
Served in 2014 or 2015
______
MorganCounty
______/ Number of Clients
Served in 2014 or 2015
______
MurrayCounty
______/ Number of Clients
Served in 2014 or 2015
______
MuscogeeCounty
______/ Number of Clients
Served in 2014 or 2015
______
NewtonCounty
______/ Number of Clients
Served in 2014 or 2015
______
OconeeCounty
______/ Number of Clients Served in 2014 or 2015
______
OglethorpeCounty
______/ Number of Clients
Served in 2014 or 2015
______
PauldingCounty
______/ Number of Clients
Served in 2014 or 2015
______
PeachCounty
______/ Number of Clients
Served in 2014 or 2015
______
PickensCounty
______/ Number of Clients
Served in 2014 or 2015
______
PierceCounty
______/ Number of Clients
Served in 2014 or 2015
______
PikeCounty
______/ Number of Clients
Served in 2014 or 2015
______
PolkCounty
______/ Number of Clients
Served in 2014 or 2015
______
PulaskiCounty
______/ Number of Clients
Served in 2014 or 2015
______
PutnamCounty
______/ Number of Clients
Served in 2014 or 2015
______
QuitmanCounty
______/ Number of Clients
Served in 2014 or 2015
______
RabunCounty
______/ Number of Clients
Served in 2014 or 2015
______
Randolph County
______/ Number of Clients
Served in 2014 or 2015
______
RichmondCounty
______/ Number of Clients
Served in 2014 or 2015
______
RockdaleCounty
______/ Number of Clients
Served in 2014 or 2015
______
SchleyCounty
______/ Number of Clients
Served in 2014 or 2015
______
ScrevenCounty
______/ Number of Clients
Served in 2014 or 2015
______
SeminoleCounty
______/ Number of Clients
Served in 2014 or 2015
______
SpaldingCounty
______/ Number of Clients
Served in 2014 or 2015
______
StephensCounty
______/ Number of Clients
Served in 2014 or 2015
______
StewartCounty
______/ Number of Clients
Served in 2014 or 2015
______
SumterCounty
______/ Number of Clients
Served in 2014 or 2015
______
TalbotCounty
______/ Number of Clients
Served in 2014 or 2015
______
TaliaferroCounty
______/ Number of Clients
Served in 2014 or 2015
______
TattnallCounty
______/ Number of Clients
Served in 2014 or 2015
______
TaylorCounty
______/ Number of Clients
Served in 2014 or 2015
______
TelfairCounty
______/ Number of Clients
Served in 2014 or 2015
______
TerrellCounty
______/ Number of Clients
Served in 2014 or 2015
______
ThomasCounty
______/ Number of Clients
Served in 2014 or 2015
______
Tift County
______/ Number of Clients
Served in 2014 or 2015
______
ToombsCounty
______/ Number of Clients
Served in 2014 or 2015
______
TownsCounty
______/ Number of Clients
Served in 2014 or 2015
______
TreutlenCounty
______/ Number of Clients
Served in 2014 or 2015
______
TroupCounty
______/ Number of Clients Served in 2014 or 2015
______
TurnerCounty
______/ Number of Clients
Served in 2014 or 2015
______
TwiggsCounty
______/ Number of Clients
Served in 2014 or 2015
______
UnionCounty
______/ Number of Clients
Served in 2014 or 2015
______
Upson County
______/ Number of Clients
Served in 2014 or 2015
______
WalkerCounty
______/ Number of Clients
Served in 2014 or 2015
______
WaltonCounty
______/ Number of Clients
Served in 2014 or 2015
______
WareCounty
______/ Number of Clients
Served in 2014 or 2015
______
WarrenCounty
______/ Number of Clients
Served in 2014 or 2015
______
WashingtonCounty
______/ Number of Clients
Served in 2014 or 2015
______
WayneCounty
______/ Number of Clients
Served in 2014 or 2015
______
WebsterCounty
______/ Number of Clients
Served in 2014 or 2015
______
WheelerCounty
______/ Number of Clients
Served in 2014 or 2015
______
White County
______/ Number of Clients
Served in 2014 or 2015
______
WhitfieldCounty
______/ Number of Clients
Served in 2014 or 2015
______
WilcoxCounty
______/ Number of Clients
Served in 2014 or 2015
______
WilkesCounty
______/ Number of Clients
Served in 2014 or 2015
______
WilkinsonCounty
______/ Number of Clients
Served in 2014 or 2015
______
Worth County
______/ Number of Clients
Served in 2014 or 2015
______

For further information contact: SCCP Program Manager, 404-651-6084, FAX 770-342-4245 orEmail .

Page 1 of 21 Revised Oct 20, 15