Cambridge and Somerville Health and Human Services Data Base

Update Status:
Edited By: Anonymous

First Time Users: click here BEFORE STARTING DATA ENTRY

Please Note: It is NOT possible to save an incomplete Program Record and return to it later to finish data entry. Click here to see our recommendations for preparing for a successful data entry experience.

Required - Name of person submitting Program Record or Record Update:

IMPORTANT: If you did not accept the editor applet when prompted, you may not be able to edit the narrative field. If you are creating a new record, please close,then re-open your browser and, when prompted, accept the editor applet.

Parent Agency Information:
	Agency Name: Enter the name of your agency, organization or group. If your program is not part of a larger agency, enter the program name here.	Example
	Street Address: Enter the mailing address of the parent agency. The address entered will be available to the public using the database	Example
	Suite, Floor, etc. Enter additional relevant information for the mailing address	Example
	City: Enter the City for the mailing address	Example
	State: MA is entered. If the mailing address state is not MA, change to the correct 2-letter abbreviation	Example
	Zip: Enter the 5 or 9 digit zip code	Example
	Phone: Enter the main phone number of the agency, including area code and extension.	Example
	TTY: List the TTY number for deaf and hard of hearing callers. Leave blank if there is no number. Callers will use the relay system number.
	Toll-Free: Enter phone number including 1-800-xxx-xxxx. Leave blank if there is no number.
	Fax: Enter the fax number including area code. Leave blank if there is no fax number.	Example
	Agency Hours: Hours that the agency is open
	Agency Description: In 25 or less words, please describe the agency:

Program Information:
	Program Name: Enter the name of the program. If there are 5 programs in your agency, a separate Program Record is necessary for each program to be listed in the database:		Example
	Contact Person: Enter the first and last name of the person to call to find out information or ask questions about this program. If the program has a central line, please enter the name of the person who will answer the phone; or, if there are multiple people answering phones, please enter “Receptionist.” **THIS FIELD IS REQUIRED		Example
	Program Address - Check here if the program mailing address is the same as the parent agency mailing address Screen will refresh and program address will be entered below.
	Street Address: Enter the address of the program where the public (consumer) can write to reach the Program Contact or to find out more about the program. This address may be different than where the program is held.		Example
	Suite, Floor, etc. Enter additional relevant contact information		Example
	City: Enter the city for the contact mailing address		Example
	State: MA is entered If the mailing address state is not MA, change to the correct 2 letter abberviation.		Example
	Zip: Enter the 5 or 9 digit zip code.		Example
	Contact Phone: Enter the phone number associated with the contact person or people		Example
	Toll-Free: Enter the phone number. 1-800-xxx-xxxx. Leave blank if no toll free number.
	TTY: List the TTY number for deaf and hard of hearing callers. Leave blank if no number is available. Callers will use the relay system.
	Fax: Enter fax number including area code. Leave blank if there is no fax number.		Example
	Contact Email Address: Enter the e-mail address of the contact person or people. If this person does not have an email address, enter either the general program e-mail address, or leave blank.		Example
	WWW: List the web address of the parent agency and/or program. Web site addresses are not case sensitive. Do not type the http://.		Example
	Program Hours: IEnter the hours and days of the week that the program is available, and the time(s) of year the program is offered. (Example: 2:00 – 5:00 pm, Monday – Friday during the school year; and 9:00 am – 5:00 pm, Monday – Friday during the summer.)		Example
	Location(s) of Program/Services: IIndicate the areas/zip codes in which your program actually operates. Individuals from other areas may be able to participate in your programs, but for this question, limit your responses to those areas/zip codes where your program is physically held or in which activities are offered.	Cambridge: 02138 Cambridge: 02139 Cambridge: 02140 Cambridge: 02141 Harvard Square/West Cambridge Central Square/Kendall Square/Central Cambridge Porter Square/Alewife/North Cambridge Lechmere/East Cambridge Somerville: 02143 Somerville: 02144 Somerville: 02145 Union Square/Central Somerville Porter Square/Davis Square/West Somerville Winter Hill/Mystic/East Somerville/Sullivan Square	Example
	Mail update requests and other database information to: Select one of the following	Parent Agency Program Both

Program Summary
Enter a brief, easy-to-read description of your program’s activities and services. This summary must be 75 words or less, and should not contain an agency description. Help
Limit: 75 words.

Target Population Narrative:
Enter a very brief description of your target population that accurately reflects the majority of people who you serve or are trying to serve. Help

Field Limit: 10 Words

**THIS FIELD IS REQUIRED

Example

Languages spoken by Staff: Enter any language that is spoken by a staff member who is available to talk to people. This may include, depending on your program structure, part time staff members and/or volunteers.	Other Languages available upon request Other Languages:
Eligibility for services may be based on: Are there requirements or restrictions about who can participate in the program based on any of the following?	No residency requirements Cambridge and Somerville Residents Cambridge Residents Only Somerville Residents Only Cambridge Housing Authority Residents Only Somerville Housing Authority Residents Only Neighborhood Residency Required (clarify below) Other Geographic Restrictions (clarify below) Income (clarify below) Age (clarify below) Disability (clarify below) Other Eligibility Restrictions or Requirements (clarify below) Clarification of Eligibility Requirements: Provide necessary information on the eligibility or enrollment process.	Example
Appointment/Referral/Registration Needed? Indicate separately if someone will need to make an appointment; to obtain a referral; or to register for the program.	Appointment Needed Referral Needed Registration Required None Needed Type of Referral: Indicate more specifics about the type of referral needed.	Example
Costs: Indicate all fee options for the program.	Fee-for-Service Sliding Scale Fee Some Free Services All Services Free Insurance/ Third-Party Payment Accepted Financial Assistance Available Other Fee info: Enter any additional information that would be helpful to explain your fee structure.	Example
Access and other Features: Click all information that will be helpful to people when coming to the program location.	Wheelchair accessible Partially Accessible to Mobility Impaired Persons Accessible to Visually Impaired Persons Accessible to Hearing Impaired Persons Parking Available Child care available Miscellaneous Access Features: Provide additional information that will assist or identify details people would need to know when coming to the program.	Example
Public Transportation: Indicate the closest T Stop OR Bus line		Example

This resource guide is a collaborative project between the Cities of Cambridge and Somerville, and the Cambridge Health Alliance, made possible by the generous support of the Agenda for Children and the Somerville Community Health Foundation.