FAMILY SELF-SUFFICIENCY PROGRAM

FAMILY SELF-SUFFICIENCY PROGRAM
If you are interested in learning more about HAYC’s FSS program, please complete the following:
Date:

MonthDayYear
Head of Household:

First NameLast Name
Mailing Address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number:

Area CodePhone Number
Email:
example@example.com
Language Preferred:
I understand this does not enroll me in the program, and I will receive additional forms to complete. A meeting with a FSS Coordinator will be scheduled to fully explain the program and, at that time, I can decide if my family would benefit from this program. This is a voluntary program that does not affect my eligibility for housing.
Should be Empty: