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.

If you would like additional information about veteran specific programs and resources, please provide the following information so that we can better assist you. An eligibility specialist will contact you within 3 business days.

* Required

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


Honorable
General
Other Than Honorable
Bad Conduct Discharge
Dishonorable
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.



Multnomah
Clackamas
Clark
Washington
None of the above

 

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