Client Questionnaire Your answers to this questionnaire will determine whether you may now be eligible for Housing Stability Services, if you are still in need of permanent housing. Please read each question carefully and provide your best answer. Our goal is to help in any way possible according to our State Guidelines. You will be contacted by a case manager if you are still in need of assistance. Name(Required) First Last Email(Required) HiddenCase Manager HiddenCase Manager Email HiddenApplication ID Are you still interested in receiving HSS Services?(Required) Yes No Please Answer Every Question BelowAre you prepared to make regular rent payments if HSS pays your application fee and security deposit?(Required) Yes No Do you need help with utility deposits?(Required) Yes No Are you in need of temporary childcare so you can maintain employment?(Required) Yes No Are you in need of public transportation?(Required) Yes No Do you need help with budgeting?(Required) Yes No Do you need help with employment?(Required) Yes No NameThis field is for validation purposes and should be left unchanged.