WSOS HomeNet Family Needs Assessment

Applicant’s Name: / No Assistance Needed
County: WOOD / Date Referral Given: / Date 2nd Appt. Follow – Up:

Emergency: Life Threatening; Needs to be resolved within 24-48 hours.

Problem: / Referred to:
No Shelter / The Link: 800-472-9411or Salvation Army: 419-352-5918 or Family House: 419-242-5505
Domestic Violence / The Link: 800-472-9411or First Step Family Violence Intervention Center: 800-466-6228
Need Food / BG FP: 419-353-5174; GR FP: 832-2325; PMBRVL FP: 287-4182; PRYBG: 666-1120
Utilities Disconnect / WSOS Utility Assistance: 800-775-9767 or Salvation Army: 419-352-5918
Need Prescriptions / The Link: 800-472-9411or Ask-A-Nurse: 800-860-6652 or Health Dept: 419-352-8402
Additional Information & Referral / The Link: 419-352-1545 or 800-472-9411

Intermediate: In Crisis; Needs to be resolved within 7-14 days.

Need: / Referred to:
Homeless Prevention / WSOS HomeNet: 800-775-9767 or Department of Jobs/Family Services 419-352-7566
Water Heater or Furnace / WSOS Housing Department: 800-775-9767
Eye Glasses Repaired / Wood Co. Health Department: 419-352-8402
Additional Information & Referral / The Link: 419-352-1545 or 800-472-9411
Transitional: Vulnerable; Needs to be resolved within 30 days.
Request: / Referred to:
Disabled Supportive Housing / WSOS HomeNet: 419-354-7407 or 800-775-9767
Transitional Housing / WSOS HomeNet: 419-354-7407 or 800-775-9767
Employment Services / One Stop: 419-352-7566 or Bureau of Vocational Rehabilitation: 800-248-8366
Child Care Options / WSOS Early Childhood: 419-353-7407 or 800-775-9767
Health Insurance Options / Department of Jobs & Family Services: 419-352-7566 or Health Dept: 419-352-8402
Income Enrichment / Department of Jobs & Family Services: 419-352-7566
Transportation Services / BG Taxi Service: 419-352-0796 or Perrysburg Area Residents – TARTA 419-340-2488
Legal Services / Legal Services of Western Ohio: 888-534-1432
Telephone Service / Ameritech USA Plan: 800-335-8721 or Verizon Lifeline: 800-483-1807
Physician &/or Dentist Options / Ask-A-Nurse: 800-860-6652 or Dental Center of N.W. O.: 419-241-6215
Mental Health Treatment Options / Behavioral Connections: 419-352-5387 or Family Services of Wood County: 419-352-4624
Alcohol/Drug Treatment Options / Behavioral Connections: 419-352-5387
Nutrition Information: Children 5 and Under and Pregnant Women / WIC: Health Dept: 419-352-8402
Additional Information & Referral / The Link: 419-352-1545 or 800-472-9411
General: Interest; Application to be completed within 60-90 days.
Request: / Referred to:
Home Repair/Weatherization / WSOS Housing Department: 800-775-9767
Home Purchase Planning / WSOS First Time Home Buyers Program: 800-775-9767
GED Classes / PENTA: 419-661-6555 or Wood County Department of Job/Family Services: 419-352-7566
Parenting Classes / WSOS Child Development: 419-353-7407 or 419-874-1482 or CRC: 419-352-7588
Family Planning Services / Wood Co. Clinic: 419-354-3540
Outstanding Bills / Debt Services / Consumer Credit Counseling: 419-334-3044 or 800-355-2227
Budgeting Education / OSU Extension Office: 419-354-9050
Vocational/College Options / PENTA: 419-661-6555 or Owens Community College: 800-466-9367
Alternative Educational Funding / Wood Co. Department of Jobs/Family Services: 419-352-7566
Business Dev. Counseling / WSOS Community & Economic Development: 800-775-9767
Senior Services / Wood County Commission on Aging: 419-353-5661
Clothing / Furniture / Appliances / Salvation Army: 419-354-0216 or Goodwill: 419-354-9726
Child Support Enforcement / ACES (Association for Children of Enforcement of Support, Inc): 800-738-ACES
Additional Information & Referral / The Link: 419-352-1545 or 800-472-9411

Signature:Staff Signature: