Page 46 - Community Resource Guide
P. 46
4. Pleaselistothersiblingsinhomewhoareeitherin pre-school, younger or college
First Middle Last
Age
Note if they are in Preschool, daycare or some other program
5. Ifdoubledup,pleaseprovidethisinformation:
Host Family Name:
Host Family Address:
Length of time you plan to stay at this address?
6. YourCurrentMailingAddress:
Address: Phone:
Contact Name:
Phone:
7. Areyoucurrentlyexperiencingalossofhousingduetoforeclosure?
qYes qNo
Please use this section to describe why you are currently in a homeless situation.
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
Page 3 of 9
Last Revised June 19, 2019
