FAMILY SELF-SUFFICIENCY ANALYSISSelect the most appropriate response in each of the following areas.This form is intended for participants of the SMHA Family Self-Sufficiency Program.NameThis field is for validation purposes and should be left unchanged.FIRST & LAST NAME(Required)YOUR EMAIL ADDRESS(Required)EMPLOYMENT OR SELF-EMPLOYMENT(Required) 3 - Employed full-time. 2 - Employed part-time. 1 - Unemployed for one month or longer.INCOME(Required) 3 - Income is always higher than expenses. 2 - Income meets expenses most of the time. 1 - Little or no income.FOOD(Required) 3 - Always have a 7-day supply of food in my home. 2 - Usually have enough food in my home to meet basic needs. 1 - Usually do not have enough food to meet basic needs.CHILDCARE FOR WORK OR SCHOOL(Required) 3 - Always have reliable, affordable childcare OR do not need childcare. 2 - Rely on subsidized childcare. 1 - Need childcare but none available or cannot afford.EDUCATION(Required) 3 - Completed a post-secondary training or educational program. 2 - Enrolled in high school or equivalent program. 1 - Did not complete high school.DIGITAL LITERACY AND ACCESS(Required) 3 - Proficient at using computers, tablets, and smart phones; have high-speed access. 2 - Limited ability to use computers, tablets, and smart phones OR have limited access. 1 - Do not understand how to use computers, etc., or choose not to use or do not have access.FINANCIAL LITERACY(Required) 3 - Understand AND benefit from modern banking, credit, and investment systems. 2 - Limited understanding of modern banking, credit, and investment systems. 1 - No knowledge of modern banking, credit, and investment systems.CIVIL OR CRIMINAL LEGAL ISSUES(Required)Consider probation, parole, child protective services, child support, divorce, traffic tickets, contract disputes, etc. 3 - No criminal history or outstanding civil matters. 2 - On probation for misdemeanors OR have pending child support case or other minor legal issue. 1 - Have outstanding warrants, a pending CPS case, or some other serious unresolved legal issue.HEALTHCARE(Required) 3 - All family members have access to affordable health care. 2 - Some family members have access to affordable care. 1 - No access to any healthcare except the emergency room.SUPPORT STRUCTURE(Required) 3 - Strong and healthy support from expanded network of family or friends. 2 - Occassional support from family or friends but often limited. 1 - No support from family or friends OR relationships are abusive or unhealthy.MOBILITY(Required)Includes issues such as mechanical condition of vehicles, driver's license, and adequate insurance. 3 - Public or private transportation is always available to meet essential travel needs. 2 - Public or private transportation is available but limited for various reasons. 1 - No access to public or private transportation.COMMUNITY INVOLVEMENT(Required)Include volunteer work, school organizations/meetings, sports, etc. 3 - Actively involved in one or more communities of people. 2 - Limited involvement and/or unsure how to get involved. 1 - No involvement in any community.MONEY MANAGEMENT(Required) 3 - Rent and other bills are always paid on time. 2 - Must choose which bills to pay on time and which to pay late. 1 - Rent and other bills are always paid late.SAVINGS(Required) 3 - Save money regularly; make only necessary withdrawals. 2 - Occassionally save money. 1 - Do not save money.CREDIT(Required) 3 - No negative credit; low debt-to-income ratio. 2 - No credit history OR credit score close to 580. 1 - All credit is negative; high debt-to-income ratio.EXERCISE & OUTDOOR ACTIVITIES(Required) 3 - Exercise regularly and spend some time outside almost every day. 2 - Exercise and/or engage in physical activity outside 2 – 3 times per week. 1 - Rarely set aside time to exercise and/or engage in physical activity.NUTRITION(Required) 3 - Most of the time I prepare balanced meals from scratch using high-quality, basic foods. 2 - Occasionally eat nutritious, balanced meals at home or dining out. 1 - Most meals are fast food and/or are highly processed, pre-packaged foods.COMMENTS OR ADDITIONAL INFORMATIONYOUR GRADE:We will do the math but if you want to do it yourself, add up the numbers of each selection, divide by 51, and enter the result below.CAPTCHA