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  1. County of Placer Health and Human Services

  2. Instructions:

    Employment Services, emphasizes goal achievement and considers the circumstances and needs of the entire family. In a goal-achievement framework, families set individual goals that are meaningful to them. Completing the following survey will help us identify your families needs by taking a look at the whole picture so we can best serve you.

  3. Your case number can be found on your EBT card. (Example-1B12345)

  4. Employment

  5. Legal

  6. Education and skills training

  7. Housing

  8. Transportation

  9. Physical and mental health

  10. Substance use

  11. Safety

  12. Child and family needs

  13. Child Care

  14. Leave This Blank:

  15. This field is not part of the form submission.