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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.
Case Number
Your case number can be found on your EBT card. (Example-1B12345)
Date:
Date:
Date:
Employment
Area of significant need
Area of need
Stable, but could improve
Making Progress
Thriving
Legal
Area of significant need
Area of need
Stable, but could improve
Making Progress
Thriving
Education and skills training
Area of significant need
Area of need
Stable, but could improve
Making Progress
Thriving
Housing
Area of significant need
Area of need
Stable, but could improve
Making Progress
Thriving
Transportation
Area of significant need
Area of need
Stable, but could improve
Making Progress
Thriving
Physical and mental health
Area of significant need
Area of need
Stable, but could improve
Making Progress
Thriving
Substance use
Area of significant need
Area of need
Stable, but could improve
Making Progress
Thriving
Safety
Area of significant need
Area of need
Stable, but could improve
Making Progress
Thriving
Child and family needs
Area of significant need
Area of need
Stable, but could improve
Making Progress
Thriving
Child Care
Area of significant need
Area of need
Stable, but could improve
Making Progress
Thriving
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