FAMILY SERVICESFamily Services Assessment • June 30th, 2020
Needs Services Y N Received Agency Social Services Y N Additional Community Services Needed Y N Referred to Another Agency Y N Has this family experienced homelessness during the program year? Y N If yes, did the family acquire housing during the program year? Y N Was this child referred to our program by a child welfare agency? Y N Was this child in foster care at any point during the program year? Y N At Enrollment End of Enrollment Receiving TANF Y N Y N Receiving SSI Y N Y N Receiving WIC Y N Y N Receiving SNAP (Food Stamps) Y N Y N
