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.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.CAPTCHAPhoneThis field is for validation purposes and should be left unchanged.