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2. 

4. 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.

   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.

6. Case Number

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

7. Date:
   Date:

   Date:

9. Employment

   1. Area of significant need
   2. Area of need
   3. Stable, but could improve
   4. Making Progress
   5. Thriving

11. Legal

    1. Area of significant need
    2. Area of need
    3. Stable, but could improve
    4. Making Progress
    5. Thriving

13. Education and skills training

    1. Area of significant need
    2. Area of need
    3. Stable, but could improve
    4. Making Progress
    5. Thriving

15. Housing

    1. Area of significant need
    2. Area of need
    3. Stable, but could improve
    4. Making Progress
    5. Thriving

17. Transportation

    1. Area of significant need
    2. Area of need
    3. Stable, but could improve
    4. Making Progress
    5. Thriving

19. Physical and mental health

    1. Area of significant need
    2. Area of need
    3. Stable, but could improve
    4. Making Progress
    5. Thriving

21. Substance use

    1. Area of significant need
    2. Area of need
    3. Stable, but could improve
    4. Making Progress
    5. Thriving

23. Safety

    1. Area of significant need
    2. Area of need
    3. Stable, but could improve
    4. Making Progress
    5. Thriving

25. Child and family needs

    1. Area of significant need
    2. Area of need
    3. Stable, but could improve
    4. Making Progress
    5. Thriving

27. Child Care

    1. Area of significant need
    2. Area of need
    3. Stable, but could improve
    4. Making Progress
    5. Thriving

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30. Email address

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