PURPOSE: To assist individuals to achieve greater stability by helping them to define key areas in their life that create barriers to obtaining and maintaining employment and housing.

REQUIREMENTS: Employment in addition to a commitment to personal change that will help overcome barriers to increased self-reliance and stability.

PROCESS: Individuals can be referred to the program by a Customer Connection Center worker, a Workforce Development team member, or another partner agency member. Individuals meet with a case manager to determine whether or not the program is a good fit for them and their needs. If individuals decide to enroll in the program, a case manager will meet with them to complete an assessment of their strengths and challenges to develop an individualized case plan for success. This case plan will serve to be a roadmap to stability with the case manager as a guide and resource.

OUTCOMES: We will focus on working with individuals to impact the following areas:

  • Employment and training
  • Housing supports and resources
  • Access to health and mental health services
  • Resolution of Legal issues
  • Basic needs, such as food, clothing, and furniture
  • Birth certificate and ID vouchers
  • Benefits assistance including SNAP and Medicaid enrollment
  • Life skills to help you with prioritizing and budgeting
  • Referrals to other providers that meet your specific needs

STABILIZATION SCREENING/REFERRAL FORM:

    First Name:

    Last Name:

    DOB:

    SSN (last 4):

    Phone Number (numbers only, include area code):

    Email Address:

    Are you currently employed?
    YesNo

    If yes, where?

    Estimated monthly income?

    If no, how long has it been since last employed?
    3 monthsLonger than 6 months

    Do you have any other sources of income (SSI/SSDI, child support, etc.)
    YesNo

    Current living situation?
    RentingStaying with friends/familyHomeless

    If renting, how much do you pay in rent/month?

    Do you have an outstanding balance with Duke Energy?
    YesNo

    If yes, how much is owed?

    Are there any minor children or other adults in the household?
    YesNo

    If yes, how many?
    Children:
    Adults:

    Name of other household members:



    Other adult monthly incomes and sources?

    Have you been involved in any other community services within the past 6 months?
    YesNo

    If yes, please specify with what agency? (Agency / Caseworker Name)

    ADDITIONAL SUPPORTS NEEDED: (Check ALL that apply)

    If other, please specify?

    COMMENTS OR OTHER CONSIDERATIONS (be detailed):

    Today's Date:

    Referred by:

    Referred Email Address: