12 month Tracking Outreach Log

Rapid Re-Housing for Homeless Families Demonstration Study

Appendix E: 12-month Tracking Outreach Log

Instructions: This form is intended to be used in cases when a study participant cannot be contacted directly at the time of the 12-month follow-up survey. In this event, the follow-up survey interviewer should reach out to the contacts (landlord, family, and friends) identified by the study participant during the initial informed consent process. Using one form per contact, all attempts to reach each contact should be documented. If the interviewer reaches the identified contacts, the interviewer should use this form to record any relevant information that could be used to locate the individual or document the person’s whereabouts. [Note: this form will be automated in a database format, and the original information will be pre-populated to facilitate the tracking process and reduce duplicative data entry.]

Contact Attempt
Contact Name		Participant’s Housing Status	 Verified participant still in same unit  Verified participant has moved – new address recorded  Verified participant has moved – location unknown  Contact was not willing to provide information about the participant
Contact Attempt Date(s)
Additional Notes from Discussion

Add participant contact information, if new information is provided.

Participant Information (Adult who signed the Participation Agreement)
First Name		Middle Initial
Last Name		Suffix
Street Address		Apt #
City		State
Zip Code		Email
Home Phone		Mobile Phone

Updated Landlord Contact Information (if the participant moved to a new unit)
Landlord’s Name		Company Name
Address (where rent is paid)		City
State		Zip Code
Work Phone		Mobile Phone