Apply to Community Teamwork

The following questions will help us identify how we can best help you. Depending upon your needs, we may be able to provide additional services or refer you to a different agency for assistance. In some cases, there may not yet be services in place to help you, but your answers to these questions will help us develop those critical services in the future. Thank you for sharing this information with us:

1 General Information
Mr.
Mrs.
Ms.
(If different)
What's the best way for us to reach you?
Home
Cell
Email
Select your Gender*
Male
Female
Date of Birth*
2 CTI Pre-Assessment

The following questions will help us identify how we can best help you. Depending upon your needs, we may be able to provide additional services or refer you to a different agency for assistance. In some cases, there may not yet be services in place to help you, but your answers to these questions will help us develop those critical services in the future. Thank you for sharing this information with us:


Are you currently behind on your rent or mortgage?
Yes
No
Are you in danger of being foreclosed on or evicted?
Yes
No
Are you homeless?
Yes
No
Do you think your housing poses a health risk?
Yes
No
Are you currently behind on your heating or utility bills?
Yes
No
Do you have enough food right now to feed yourself and your family?
Yes
No
Do you need help finding or paying for Child Care?
Yes
No
Does any adult in your household need help obtaining a high school diploma or GED?
Yes
No
Does any adult in your household need help improving their English language skills?
Yes
No
Is transportation a problem for you or anyone in your family?
Yes
No
Does anyone in your household need help finding a job?
Yes
No
Do you need assistance finding more affordable or subsidized housing?
Yes
No
Are you interested in Budget education, credit repair or Financial Literacy Assistance?
Yes
No
Do you have health insurance?
Yes
No
Are you interested in starting a small business?
Yes
No
Are you interested in learning farming skills or beginning a farming business?
Yes
No

Thank You for your interest in Community Teamwork.