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Legal Foundation of Washington
Age and Ethnicity Report
Program:
Report from _______________ to _______________
(month/year) (month/year)
Under 1818-5960 and OverTOTALWhite/non-HispanicBlack/non-HispanicHispanicNative AmericanAsian/Pacific IslanderOtherTOTAL
The Legal Foundation of Washington asks its grantees to track and report the age and ethnicity of the clients served semi-annually. Use this form if your program does not use case management software that automatically generates this Information. All programs should make these questions part of the intake process, and develop a way in which you can record, update and report this information. This form is due semi-annually with the narrative report and the CSR/CRF.
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