STEPS UP

We are finding that many homeless people can receive our help and go through our program, even if they are not in a location where our shelters are. It does, however take a willingness to overcome the obstacles that put you in the homeless condition to begin with.

Self training is difficult for someone who has a steady home. But it is still possible for a homeless person who is dedicated to the task of self improvement, to read the coursework, apply it to their life, and overcome the situation they are in.

We understand how dire things can become, and the many reasons why people become homeless. However, in order to help you, wee need some basic information about your past and present situation. Your past does not forge your future, but often it needs to be addressed before you can move forward in life. We would appreciate it if you would tell us a little about yourself.

Travel to HungaryThe information is for our records only, and none of this information will be shared with any other agencies without your prior permission.
Keep in mind that these questions are the EXACT same questions asked on many job applications, and may be used for employment purposes in the future.
These questions are not to disqualify you from the program. Honesty is of the utmost importance. We can not help you overcome the obsticals in your life if we do not know they exist.

Please fill out what questions you can

For our record keeping Purposes:

First Name                        Last Name

Social Security Number

If you are staying somewhere, even if it is only temporary, or under a bridge somewhere, we need to know where so that we can get in contact with you.

Address (if available)
City                                 State Zip

Email Address (If you have one)
Are you 18 years old or older? Yes No
Contact Phone Number (if you have one)

Best Time to Call

Needs Assessment

How (in your own words) did you become homeless?
What circumstances put you into this situation?

How long have you been homeless?

What Job Skills do you have?

What Education do you have?

Are you a US Citizen? Yes No

Name your last 3 employers, their addresses & phone numbers, employment dates (aproximate) and reasons why you left:
Employer Address Phone
Employment Dates:
Start Date Finish Date
Job Title

Job Description / Skills Used

Reasons why you left:

Employer Address Phone
Employment Dates:
Start Date Finish Date

Job Title

Job Description / Skills Used

Reasons why you left:

Employer Address Phone
Employment Dates:
Start Date Finish Date

Job Title

Job Description / Skills Used

Reasons why you left:

Are you a Veteran of Military Service? Yes No

IF in the military, which Branch

IF in the military, what were your service dates

IF in the military, what was your job title / MOS?

Impediments

There are certain things that can stand in your way of being reintegrated with "normal" society. That's not to say that you can never live a normal life again, but that there are things you must do in order to make that happen.

In order to help you, we NEED to know if there is anything standing in your way to getting help. We can not help you solve these problems unless we know they exist. Please answer these questions honestly, and remember - this information is for our records only. WE WILL NOT SHARE this information with ANY other agencies without your express written permission.

What important documents do you have in your possession? (Driver's license, Birth Certificate, DD214, SS card, Green Card, etc)

What important documents have you lost or do you need to obtain? (Driver's license, Birth Certificate, DD214, SS card, Green Card, etc)

Have you ever been a convicted felon?

Do you presently have any outstanding warrants?

Do you ever drink or do "recreational" drugs? If so, how long, what kind?

Have you ever had alcohol problems? If so, how long, what kind?

Have you ever had drug problems? If so, how long, what kind?

What is the best way for us to contact you?

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Homeless Helplist Application

Travel to HungaryThe information is for our records only, and none of this information will be shared with any other agencies without your prior permission.

Please fill out what questions you can

For our record keeping Purposes:

Needs Assessment

Impediments