FSS PARTICIPANT STATUS REPORTYour FSS Coordinator will contact you after reviewing your report.First & Last Name(Required)Employment(Required)Full-timePart-timeSelf-employedUnemployedName of Employer(s)(Required)Hourly pay(Required)Hours per week(Required)Self-Employment Details(Required)If you are self-employed, tell us what you are doing and how much you earn per month, after expenses (net income).Do you get TANF?(Required)YesNoAppliedTraining/Education(Required)Not In TrainingTraining in progressCompleted trainingName of Training Program & Provider(Required)Tell us what type of training or education you are getting, who is providing it, and when you expect to complete it.Training Details(Required)If you completed a training/education course, tell us what is was, who provided it, and when you completed it.Goals Timeline(Required)Example: Take GED test in December and get full-time job in January.Finances (Budget, Bills, Savings, Credit Report)Check each statement from the list below that applies to you. Select All I use a written budget each month. I pay my bills on time each month. I save at least a little money each month. I have examined my credit report in the last 6 months.Legal Status(Required)No legal issuesHave legal issuesLegal Issue Details(Required)Provide information on the type and severity of the legal issue, if applicable.Wellness(Required)How are you doing, physically and emotionally?What help or resources do you need?(Required)Other Comments(Required)Please share any other info about what is going on in your life that may be relevant to your goals.Best Times to Meet in Person or Talk by Phone(Required) Mornings Mid-day Afternoons After 5 PMPhone number(Required)Email(Required)CAPTCHAUntitledUntitledPhoneThis field is for validation purposes and should be left unchanged.
