Atlanta Mission Client Stability & Success Follow-Up We’d love your feedback! "*" indicates required fields Δ Contact IDStaff Performing Survey First Last Name* First Last Months Since Exit:* 6 –11 months 12- 17 months 18 -23 months 24- 29 months 30- 35 months 36 months+ Support SystemDo you have reliable support within the community (friends, church, mentors, etc.)?* Yes No Somewhat Briefly describe your support network:*Faith & Spiritual LifeAre you currently active in a church or spiritual community?* Yes No Occasionally Would you like to be connected with a church or spiritual mentor?* Yes No EmploymentAre you currently employed or in job training/school?* Full-time Part-time Job training/school Unemployed If employed or in training, how is it going?*Financial StabilityAre you able to meet your basic needs with your current financial resources?* Yes No Sometimes HousingHousing* My own apartment/home Transitional housing Staying with friends/family Shelter Homeless TransportationDo you have reliable transportation for work, appointments, and errands?* Yes No Sometimes SobrietyIf you’ve had a history of substance abuse, have you remained free from drugs and alcohol in the past 6 months? Yes, completely Mostly, with some slips No Prefer not to say Not applicable Mental & Emotional Outlook*On a scale from 1 (Not Hopeful) to 5 (Very Hopeful), how hopeful do you feel about your future right now? 1 – Not Hopeful 2 – Somewhat Not Hopeful 3 – Neutral 4 – Somewhat Hopeful 5 – Very Hopeful Short- and Long-Term Goals*
