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CARES T.E.A.M. Services Request
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Norfolk CARES T.E.A.M. Services Request
First Name
*
Last Name
*
Date of Birth
Date of Birth
please enter the mm/dd/yyyy for your date of birth.
Email address:
Telephone number
Address1
City
State
Zip
Are you currently receiving SNAP benefits?
*
Yes
No
Do you have any children 0-18 years old on your SNAP case?
*
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No
N/A
If you do not receive SNAP benefits, please select N/A
Are you currently receiving TANF benefits?
*
Yes
No
Do you currently Live in the City of Norfolk?
*
Yes
No
Have you ever been convicted of a misdemeanor or felony charge
*
Yes
No
Are you a youth or young adult (age 17-24) who is transitioning out of foster care?
*
Yes
No
Are you a non-custodial parent with a Department of Child Support Enforcement case with TANF debt?
*
Yes
No
Are you between the age of 18-49 years old?
*
Yes
No
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