Family Assessment Form

Credit Report
Family Assessment

Personal Information

First
Last
First
Last
First and Last
Month, Day and Year
Cost per child
First and Last
Month, Day, and Year
cost per child
First and Last
cost per child
First and Last
Month, Day and Year
Cost per child
First and Last
Month, Day, and Year
Cost per child
First and Last
Month, Day and Year
Cost per child

Housing

Family's Current Address
City
State/Province
Zip/Postal
i.e. Behind on rent, unsafe living situation, possible eviction
How much is your monthly rent or mortgage payment?/Are you behind?/If so, how far behind?
Who, Relationship to you, how long have you lived together? etc.
When? Where? How Much?
How much? Who from?

Employment

Transportation

Cost per month/total loan amount/past due/other info

Medical Background

Please explain.
Please explain.

Benefits and Finances

Include wages and child support
Please Describe
Please describe what and how much is owed for each item.

Additional Information

Needs

What are the main problems that you or your family are dealing with at this time?
Please explain why you would be a good fit for our ministry.
Sending