SSVF: Program Participant Agreement As a participant in the SSVF Program, I/We,Agree (Please check all to which you agree)Untitled To complete an initial intake. To complete an assessment with my assigned case manager. To answer all questions To be an active participant in the development of my service plan To work in collaboration with my case manager, other service provider staff, and property owner to maintain my/our housing. To work toward credit repair which may require making monthly payments towards past due rental evictions or outstanding utility bills. To meet with my/our case manager at least once a month To attend workshops related to financial literacy and/or employment services To schedule and attend drug screening and mental health assessment as required by case manager To allow my/our case manager to meet with me/us in my/our home. I/We agree to the terms and requirements to receive SSVF services. I/We also understand that providing false information may result in disqualification and termination from the program. I/We understand that this is not an entitlement program. Decisions on participation are based on a review of information about a household and whether that household meets the criteria that are outlined in the Federal program regulations, the availability of funds, and staff needed for participation. Client SignatureDate Month Day Year Client SignatureDate Month Day Year Staff Signature Date
