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FAMILY SUPPORT ASSESSMENT

FAMILY SUPPORT ASSESSMENT

Sentinel City® Student Report

Leila Safavi [email protected]

West Coast University (canvas)-2147387035

5/12/2021

6/17/2021

Name:

ID:

First Access:

Last Access:

Email:

Tenant:

16 hrs 10 mins3 hrs 28 mins12 hrs 42 mins

Total Time SpentTime in AssessmentsTime in City

FAMILY SUPPORT ASSESSMENT 100%Progress: Time Spent: 3 hrs 27 mins

NonNon

RelationshipName

Boy friend/ Brandi’s father (Jessi)Jessi

RelationshipName

3No

Total Household Occupants (Include Client)Ability to Pay Other Monthly Bills

No$1,250

Ability to Pay Rent / MortgageRent / Own

YesChild support

Child SupportOther Sources of Income

$544/MonthYes

Total Annual Income from EmployerEmployment Status

High School Grad

Highest Level of Education Completed

EnglishUnknown

Primary Language Spoken At HomeReligious Preference

SingleNonWhite/Non-Hispanic

Marital StatusAgeRace/Ethnicity

Candice Conway

Client Full Name

06/17/2021Leila Safavi

DateInterviewer Completing this Assessment

ADULTS IN THE HOME

FINANCIAL

GENERAL FAMILY INFORMATION

Page 1 of 3Friday, June 18, 2021

Sentinel City® Student Report

Leila Safavi [email protected]

West Coast University (canvas)-2147387035

5/12/2021

6/17/2021

Name:

ID:

First Access:

Last Access:

Email:

Tenant:

16 hrs 10 mins3 hrs 28 mins12 hrs 42 mins

Total Time SpentTime in AssessmentsTime in City

Confused

Newborn care

Confused, not sure about the father

General Childcare Arrangements / Concerns

Not sure

Child Support

JessiNo information

Information about child’s fatherPlans to breastfeed or bottle feed

No24 weeks

Prenatal care?How many weeks?

Yes

Is client currently pregnant?

Female2Brandi

GenderAgeChild

NonNo information

Are there medical issues with this child?Are Immunizations up to date for this child?

Jessi (Current boy friend)

Information about child’s father

(Sometimes $214 a week by her dad)

Child Support

Yes ($1,100 disability check monthly, and $250 a week by his dad)

Child Support

Randy (ex convict)

Informati

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