PHONE CALLASSISTANCE NEEDED
ADDRESS AND PHONE
RENT
LIFE THREATENING EMERGENCY?MORTGAGE
IF SO CALL 911 OR GO TO ER TRANSPORTATION
FOOD
PHONE INTERVIEW INTAKE INFORMATIONJOB
SPIRITUAL COUNSELING IF DESIRED
RENEW- YOUR MIND
RESTORE-YOUR SOUL
REBUILD-YOUR LIFE
IF NOT HOMELESS SEE PREVENTIONPHYSICAL
MENTAL
IF YOU CAN’T WORK WE CAN’T GIVE HOUSING
NEED BENNET FORM COMPLETED FULLY ASAPMEDS
MUST BE WILLING TO GIVE COPIES SOC. SEC. AND UTILITIES
PICTURE ID REPAIRS
PRESENT SITUATION (YOUR STORY) CHILD CARE
PRESENT LOCATION RIGHT NOW PHONE BILL
LOCAL OR OUT OF TOWNABUSE
IF LOCAL LAST ADDRESSREFERAL
IF FROM OUT OF TOWN WHERE FROM, WHY AND HOTLINE NUMBERS
HOW LONG HEREMARITAL
NO ADDICTIONS OF ANY KIND
NO WARRANTSDIVORCE
NO BACK CHILD SUPPORT MORE THAN $250SEPERATION
NO SERIOUS MENTAL OR PHYSICAL DISSABILITIESBENNET FORM IF HELPED
SEE CRIDER MENTAL HEALTH CENTER
HAVE TO BE WILLING AND ABLE TO WORK
NO CON ARTISTS OR SYSTEM USERS
ARE YOU RECEIVING BENEFITS
DO YOU HAVE A CASEWORKER
ALONE OR HAVE PEOPLE WITH YOU
IF CHILDREN WHAT IS RELATIONSHIP
MARRIED OR NOT, RELATIONSHIP
WORKING
HOW LONG HOMELESS AND WHY
FRIENDS OR FAMILY
WILLING TO FOLLOW PLAN AND PROGRAM AS DIRECTED
OTHER POSSIBLE TYPES OF SUPPORT AVAILABLE
USE OWN RESOURCES FIRST
IF SOON TO BE HOMELESS
WHEN
WHAT IS CAUSE
OWN RESOUCES
UNDERLYING PROBLEMS
PRESENT ADDRESS AND PHONE #
HEALTH
DOCTOR AND MEDS IF NEEDED
GOOD OR POOR –EXISTING CONDITIONS
FSD FOR MO. HEALTH NET
WORKING
CAN PROVIDE LIMITED EMERGENCY SHELTER
WHERE NOW WORKING
HOW LONG
WHAT DO YOU DO
TRANSPORTATION
BOSSES NAME AND PHONE
NEED PROOF OF EMPLOYMENT
HOW MUCH IS TAKE HOME PAY
WHEN IS PAYDAY
CAN HELP WITH PERMANENT JOBS
NOT WORKING
HOW LONG SINCE LAST JOB
WHERE
DUTIES
REASON FOR LEAVING
FUTURE PLANS FOR EMPLOYMENT
CONTACTS FOR NETWORKING
TEMP AGENCIES APPLIED TO
APPLICATIONS PER DAY (15 REQUIRED)
RESUME OR CAREER CENTER
SKILLS AND EDUCATION
CERTIFICATES, LICENSES ETC.
DESIRED JOB
CAREER PLANS AND GOALS
CAN’T PROVIDE HOUSING BUT WE CAN ASSIST IN FINDING
WILL GIVE JOB COUNSELING
FOOD
HOW MUCH PRESENTLY IN POSSESSION
LAST TIME AND DAY ATE
EMERGENCY FOOD BOX AVAILABLE IF YOU HAVE NO FOOD NOW
FODD PANTRY LIST
INFANT NEEDS, DIAPERS ETC.
CLOTHES
HAVE VOUCHER FOR MARY MARTHA FOR FREE CLOTHES
CAN TAKE TO GOOD WILL OR SAL ARMY STORES
TRANSPORTATION
OWN CAR
CURRENT WITH ALL PAYMENTS
VEHICLE LEGAL
REPOED
TAGS
INSURANCE
DRIVERS LICENSE
GOOD RUNNING CONDITION
WHAT REPAIRS ARE NEEDED IF NEEDED
NEED GAS
NO CAR
BICYCLES AVAILABLE
FRIENDS OR RELATIVES
FSBH CAN PROVID LIMITED TRANSPORTATION
COMMUNICATION
CELL PHONE
WE WILL PROVIDE IF FUNDING IS AVAILABLE
FRIENDS OR RELATIVES
COMPUTERS ARE FREE AT LIBRARY OR CAREER CENTER
SHELTERS
SAL ARMY
YOUTH IN NEED
OUR LADIES INN
OTHER REFERALS OR HOTLINES AVAILABLE