Program Eligibility Please be truthful in your responses, you will need to verify all information 1. Have you been assisted by COMPASS within the past 12 months? Select one: Yes No 2. Are you a resident of Franklin County? Select one: Yes No 3. What best describes your current source of income? Select one: Employment VA Unemployment SSI Other 4. Is the eviction or utility disconnect scheduled within 48 hours? Select one: Yes No 5. Will you be able to provide ALL required documents? To qualify for assistance, you will need to be able to provide the following documents: Eviction, utilities disconnect, or late notice Household employment verfication showing pay rate and hours (if unemplyed, most previous paystubs from prior employment) A signed lease agreement Documents showing why you are unable to pay your rent or utilities this month (example: paystub showing less hours, etc.) Proof you can sustain the household the following month (example: new hire documentation, letter of pay increase, etc.) Your identification (example: drivers license) Ledger or statement of late balance from the landlord Yes No 6. Are you over 50 or under 50 years of age? Over 50 Under 50 7. Is there at least one minor or pregnant adult at home? Yes No