FSS Goal Sheet Name* First Last Address* Phone*Email Who is your FSS caseworker?* Zoe Parakuo Everett Brubaker I'm not sure FSS Monthly Goal SheetThe FSS Goal sheet is a required part of the program, due every month by the 10th. The Goal sheet is there to communicate with your caseworkers, check in on your goal progress, and request any help with your goals or family needs. Questions? 540 437 9545 Goal Sheet Month Job/Employer*Put "not working" if unemployed Hours per week* If not working what is keeping you from working? If not working, how can FSS assist you in getting a good job? Connect me with Career Works for help finding good jobs Assist me with making a strong resume or cover letter Assist me with finding programs to get new skills or certifications Other Are you struggling with rent, keeping a budget, or something else we can help with? If you have kids, how many are currently in childcare?* If you do not have kids, put "n/a" If you need help finding childcare please call us to explore options. 540 437 9545 What assistance are you currently receiving (this month)?* TANF Food Stamps Medicaid or Child's Health Insurance Program Earned Income Tax Credit Do you want to meet in person or over the phone with your caseworker this month? Yes please contact me to schedule a meeting Not right now Classes I am currently takingPlease list all classes you are currently taking or enrolled in and the time frame. Classes I am interested inPlease list any classes you are interested in. We are happy to help with enrollment, finding scholarship, and more! Escrow Savings AccountDo you have any question about the escrow savings account? Goals and Action Steps*Please write your 2 or 3 main program goals. Next to each, please write what step you will take this month to get closer to that final goal. End of FormAny questions or comments?Signature* Today's Date MM slash DD slash YYYY Upload Document or PictureMax. file size: 512 MB.You can upload a document, picture of goal sheet, or anything else.