Virtual Needs Assessment
Welcome to the Family Promise Virtual Intake. Family Promise provides homeless and self-sufficiency services to working families with children in the throughout North Central Florida. The information provided here will help to determine the type of services your family needs. When a case worker has the time we will review your situation. You will ONLY receive a call or email from us if we have any resource that may be able to help or if we have additional questions. Walk-ins are not accepted. 
Email *
Name *
Date of Birth *
Phone Number *
How many people are in your household? *
Is anyone pregnant? *
How many children in the home under the age of 18?  *
What County Are You Currently In? *
Are you currently employed? *
Is access to childcare preventing you from working? *
Is anyone in the household disabled? *
Do you have a vehicle? *
Where are you currently staying? *
Do you receive food stamps? *
Are you in need of food? *
Are you in need of diapers?
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Do you have a High School Diploma or GED *
Would you be interested in furthering your education or receiving a career certification? *
Please provide details about your current situation and the assistance that you are looking for? 
End of Assessment
Thank you for answering the assessment. When a case worker has the time we will review. You will ONLY receive a call from us if we have any resource that may be able to help or if we have additional questions.
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