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Potential Family Eligibility Checklist
Family Promise of St. Tammany
This is only part of the initial screening process. Families meeting the below eligibility guidelines, may be a fit for the program and, if interested, can be referred for available services.
THIS FORM MUST BE REVIEWED WITH THE CLIENT AND COMPLETED IN ORDER TO BE CONSIDERED FOR OUR PROGRAM
Primary Family Member Name
First
Last
Primary Family Member Phone
###
-
###
-
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This is a family unit including at least one child (under the age of 18 years old)?
*
Yes
No
This is a family who is currently homeless or on the verge of becoming homeless due to current financial hardship?
*
Yes
No
Does each adult family member have a form of identification: Birth Certificate, SS Cards, or DL, etc. and can show proof of residency in St. Tammany Parish for at least the last 30 days?
*
Yes
No
Does the family have a source of income or the ability and willingness to gain employment?
*
Yes
No
Has the family supported itself in the recent past and has a goal to self-sustain in the future?
*
Yes
No
Is the family willing to enter into a program which could ease living expenses, provide a place for the family to sleep, and provide meals WITH supervision by the program director and with certain expectations and responsibilities assigned to the family?
*
Yes
No
Is the family free of major credit issues. And if not, is the family willing to take money management classes and/or begin credit counseling services?
*
Yes
No
Does the family’s primary provider have transportation with a valid driver’s license or is the family willing to be transported by the program’s 15 passenger van?
*
Yes
No
Are the children in the family up-to-date on their immunizations?
*
Yes
No
Is no member of the family currently abusing any substance(s) and/or is under current treatment for any addiction. (No use of alcohol or illegal drugs is allowed in the program)?
*
Yes
No
Has no family member recently been hospitalized or under intense treatment for a mental health issue?
*
Yes
No
Does no family member have a current immigration status issue or domestic violence complaint?
*
Yes
No
Does no family member have a criminal record of a sexual or violent nature?
*
Yes
No
Will the family agree to possessing no weapons at any of the facilities of the program?
*
Yes
No
Will the family agree to treat with respect all staff, volunteers, and other guests?
*
Yes
No