Page 61 - index.html

d Start
hips, changing lives”

rship Profile
Your Name:

ur family currently How long has your family lived at its

present address?

ment Hotel/Motel Less than 6 mths 6-12 months

Mobile Home 1-2 years More than 2 years

Transitional Housing

Has your family ever been homeless during the last 12 months?

(Including currently homeless) Yes No

IF YES, indicate the amount of time spent homeless:

Less than 1 mo 1-3 Mo 3-6 Mo More than 6 mo

TENDING/RECEIVING?

Counseling Job Search Substance Abuse

Discipline College Immigration/Citizenship

Vocational Training

Y GOAL PLEASE IDENTIFY FAMILY GOAL

TIMETABLE:

DATE:
DATE:

18