Supportive Services for Veterans Families (SSVF) Applicant Information Form (Screening) Supportive Services for Veteran Families (SSVF) is a case management program for homeless, or at-risk for homelessness, Veterans, and their families. SSVF Case Managers will assist you with identifying and addressing barriers, increasing self-sufficiency, and securing permanent housing. We work closely with the VA and other community service providers to ensure that our clients are connected with any and all resources available to them. Please fill out the following information so that we are able to begin determining eligibility. Applicant Name:*Spouse/Partner Name (if applicable):Number of dependents living with you:Phone Number:Email:* Please check all that apply I, or the Veteran in my household, served in the active military, naval, air service, Merchant Marines, or was activated by Presidential order and served in another state or country while in the National Guard or Reserves My discharge status was not dishonorable Where are you located?AnchorageMat-Su ValleySelect one. I am currently*HomelessAt risk of homelessness (I have an eviction notice)If you are currently homeless, how long have you been homeless?I am currently spending my nights* On the street/campground or in my car In a hotel/motel In my own apartment but I have an eviction notice Emergency Cold Weather Plan With a friend or family member Other If other, please explainAre you currently employed?*YesNoIf yes, where? And approximately how many hours per week?Is your spouse employed?YesNoNot ApplicableIf yes, where is your spouse employed? And approximately how many hours per week?Do you receive any of the following?* ATAP/TANF SSI/SSDI VA Disability VA Unemployment Child Support Native Corporation Dividend Food Stamps Other None of the above If other, please explainWhat is your total estimated monthly income?Where did you hear about our program?*Have you received services from Catholic Social Services before?*YesNoIf yes, what type of service?Is a referring agency filling out this form?*YesNoFiling Agency Completing Form:*Name:*Person Completing FormPhone Number:*Email:*