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OXFORD HOUSES OF VIRGINIA

RESIDENT ACTIVITY REPORT

HOUSE NAME: YEAR:

REPORTING PERIOD: CALENDAR MONTH

JAN FEB MAR APR MAY JUN JUL AUG SEP OCT NOV DEC
1. TOTAL NUMBER OF BEDS IN YOUR
HOUSE (MAX CAPACITY)
2. NUMBER OF RESIDENTS AT END OF
REPORTING PERIOD
3. NUMBER OF VACANCIES AT END OF
REPORTING PERIOD
4. NUMBER OF APPLICATIONS RECEIVED
DURING REPORTING PERIOD
5. NUMBER OF RESIDENTS ADMITTED
DURING REPORTING PERIOD
6. NUMBER OF VOLUNTARY DEPARTURES
DURING REPORTING PERIOD
7. NUMBER OF DEPARTURES DUE TO
RELAPSE DURING REPORTING PERIOD

8. NUMBER OF DEPARTURES FOR OTHER


REASONS DURING REPORTING PERIOD

9. TOTAL NUMBER OF DEPARTURES


DURING REPORTING PERIOD

The Secretary of each Oxford House shall report the House resident activity for the reporting period to the Chapter Secretary. The House will also report this
information at the monthly Chapter Meeting.

This report provides vital information on the success of the Oxford House program and the need for more houses.

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