SSVF Pre-Screening Form


If you would like to determine your eligibility for the SSVF grant, please complete the form below. Your responses will be sent to the SSVF screener, who will contact you further.

The SSVF grant provides low-income Veterans and Veteran families with case management services, rental assistance, utilities assistance, child care costs, moving costs, transportation expenses, emergency supplies, and security deposits on a short term basis.

If you are a veteran seeking services in Clark County please call the Council for the Homeless intake hotline at (360)-695-9677.

* Required

To qualify for the SSVF grant, you or someone in your household must have served in the U.S. Military.

Other Than Honorable
Bad Conduct Discharge
Other, please specify:

 Housed, at risk of receiving eviction notice
 Housed, have written eviction notice
 Staying with friends/family
 Staying in a hotel/motel, paying for yourself
 Staying in a hotel/motel, paid for by a charitable organization
 Living in a place not fit for habitation (ie. garage, tent, place without a running water or electricity)
 Shelter, GPD program, etc.
 Other, please specify:

The value must be greater than or equal to 1.

None of the above


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