I have the following documents (Mark all that apply)
ID card and/or Driver's License
Social Security Card
Birth Certificate
Education Level
Some high school
High school diploma
Some college
College Degree (specify______________________)
Work Experience
I have never had a job
0-3 years
3-6 years
6-10 years
10+ years
Living Situation
Temporary Shelter/ halfway house
Live with relatives
Live with roomates
Live on own
Work status
Unemployed
Part-time job
Full-time job
Disabled/unable to work
I know where to go to apply for assistance such as food stamps, medi-cal, rent etc.
Yes
No
I will need to obtain services for substance abuse
Yes
No
N/A
Transportation
Own a car
Bus
Bicycle
None
Other (please specify)
I currently have a:
Savings Account
Checking Account
Other
None
I would like assistance or more information on the following:
Please list:
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