CITY LOCALS APPLICATION - SECTION 4

SELF SUFFICIENCY

THE FOLLOWING QUESTIONS SHOULD BE ANSWERED BASED ON YOUR OWN PERSPECTIVE. PLEASE UNDERSTAND THAT EACH SKILL SET/TOPIC MAY BE EVALUATED AT THE DISCRETION OF SOUTHWIND FIELDS STAFF BEFORE ADMITTANCE TO THE PROGRAM AND AGAIN, INTERMITTENTLY, THROUGHOUT YOUR PARTICIPATION IN THE CITY LOCALS PROGRAM, AT THE DISCRETION AND/OR REQUEST OF ANY MEMBER OF YOUR CARE TEAM.

Name

First Name

Last Name

UNDERSTANDING OF EXPECTATIONS

ABILITY TO FOLLOW DIRECTIONS

COMMITMENT TO MEET PROGRAM EXPECTATIONS

WILLINGNESS TO PARTICIPATE IN ACTIVITIES

WILLINGNESS TO MEET REGULARLY WITH STAFF

SELF TRANSPORTATION SKILLS

MONEY MANAGEMENT SKILLS

ABILITY TO COMMUNICATE PERSONAL NEEDS

COOKING SKILLS

ABILITY TO INTERACT APPROPRIATELY WITH FAMILY AND FRIENDS

ABILITY TO HOLD A TWO PERSON, BACK AND FORTH, CONVERSATION

PERSONAL HYGIENE SKILLS

ABILITY TO DO LAUNDRY INDEPENDENTLY

ABILITY TO MAINTAIN PERSONAL LIVING SPACE

ABILITY TO LIVE INDEPENDENTLY

MOTIVATION TO MAINTAIN EMPLOYMENT

UNDERSTANDING OF MEDICAL NEEDS

PEDESTRIAN SAFETY SKILLS

ABILITY TO LEARN MORE THAN ONE BUS ROUTE

ABILITY TO MAINTAIN SELF CONTROL WHEN ANGRY OR EXCITED

ABILITY TO BEHAVE APPROPRIATELY IN PUBLIC SETTINGS

ABILITY TO MAINTAIN SAFETY WHEN INTERACTING WITH STRANGERS (i.e. on a bus or plane, while in Uber, etc. - will not give out personal information or allow/invite someone to touch you)

ANYTHING ELSE WE SHOULD KNOW?

If you have been arrested in the last 10 years or have something that may appear on your background check, please consider disclosing it here.

SOUTHWIND FIELDS IS A NONPROFIT 501(C)3 ORGANIZATION

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