STATE OF CALIFORNIA HEALTH AND HUMAN SERVICES AGENCY                                                                                         CALIFORNIA DEPARTMENT OF SOCIAL SERVICES

CalWORKs can help you if you or your family members are facing a crisis or situation that is preventing you from being able to participate in Welfare-to-Work. You can ask the County Welfare Department to help you with your crisis or situation.

INSTRUCTIONS: All information must be completed. Both the Welfare-to-Work case worker and Welfare to-Work participant must sign the form. A copy is given to the Welfare-to-Work participant, and a copy is kept in the participant’s case file.

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CalWORKs can help you if you or your family members are facing a crisis or situation that is preventing you from being able to participate in Welfare-to-Work. You can ask the County Welfare Department to help you with your crisis or situation.

INSTRUCTIONS: All information must be completed. Both the Welfare-to-Work case worker and Welfare to-Work participant must sign the form. A copy is given to the Welfare-to-Work participant, and a copy is kept in the participant’s case file.

CalWORKs Employment Services

I. PROGRAM PURPOSE – The CalWORKS Employment Service’s Program is a comprehensive statewide

employment program designed to enable participants to achieve self-sufficiency through employment. The intent of the program is to provide employment and training services to adult recipients of CalWORKs cash aid.

II. REASON FOR RELEASE – To ensure you receive the widest range of CalWORKs services. Your employment

counselor may need to communicate with staff from other agencies, non-profit organizations, and other departments on your behalf. All have agreed to cooperate to better serve you and to protect your confidential records. Your signature on this form gives your written consent to Nevada County Department of Social Services, CalWORKs Employment Service’s program to exchange information related to your CalWORKs services and develop a plan of activities for you. 

NEVADA COUNTY DEPARTMENT OF SOCIAL SERVICES ● P O BOX 1210 ● NEVADA CITY, CA 95959

WTW 500 - Authorization To Release Confidential Information

Section 2 – Customer /Household Information

Correspondence:

Section 3 – Housing Situation

Section 5-Housing Response

Nevada County Family Stabilization and Housing Support Program Contract

The Family Stabilization and Housing Support Programs are here to support you while your family is going through a temporary crisis. These programs are intended to get you back to a place in which you can participate in the Welfare to Work program and continue working toward your long-term goals.

Eligibility for the the Family Stabilization Program is available to families who:

• Are experiencing an unsafe situation due to domestic violence
• Have legal concerns, fines, or fees that are preventing them from participating in employment or other activities
• Need help with connections to substance abuse, mental health, or behavioral health treatment (including children’s mental health needs)
• Are at imminent risk of homelessness due to temporary inability to pay rent or utility bills
• Are experiencing another type of crisis that is preventing them from participating in Welfare to Work

Eligibility for the Housing Support Program is limited to families who are homeless and:

• Living in a place that does not have running water or hookups (a place not meant for human habitation)
• Living in a residential treatment facility, transitional house, or shelter
• In receipt of a formal court-ordered eviction

Couch surfing with friends and family does not meet criteria for the Housing Support Program, but services may be available through the Family Stabilization program or other county programs.

Families are asked to contact 211 and get on the By Name List as part of the HSP application and will be referred in order of need.

 

By signing up for the Family Stabilization and/or Housing Support Programs, you agree to:

You also understand that: