Vulnerability Assessment for Food/Supply
We will review your information to determine if you qualify for assistance. A family liaison will be in contact with you if more information is needed. Thank you.
Parent/Guardian Full Name *
Please list the names of your students and where they attend school *
Phone or Email *
Address (if you are homeless, please enter 'n/a') *
How many people live in your household? *
Are you experiencing housing instability, living doubled up with family/ friends, moving frequently, facing eviction, living in substandard housing, or experiencing immigration challenges? *
Is your family eligible to receive a government stimulus check? *
Do you receive EBT Food Benefits every month? *
Which statement best describes your current need of food? *
Which statement best describes your current need for household supplies? *
Select all SUPPLY items you need most:
Select all FOOD items you need most.
How often does this Family need food/supply assistance? *
Is there anything else you want us to know?
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This form was created inside of Shelton School District.