Screening Questionnaire Logo
  • Screening Questionnaire

  • How will you be able to pay?

  • Will you be able to provide an Award Letter confirming payment assistance ?

  • Do you have a mental health diagnosis? if yes, what medication do you take?

  • Have you been diagnose schizophrenic?

  • Are you independent (self sufficient) if NOT, what kind of assistances do you need?

  • Should be Empty: