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Please fill out this form to get more information on our HPRP Program
Do you live in Springfield, MO city limits?
Yes
No
Does the Individual/Family currently have an eviction notice or utility disconnect notice?
Yes
No
Does the Individual/Family have social supports or other means of avoiding disconnection or homelessness?
Yes
No
Have you ever been homeless?
Yes
No
Have you ever been evicted from a residence that was leased in your name?
Yes
No
Have you ever been convicted of a felony?
Yes
No
Is your current residence in leased in your name?
Yes
No
2nd Annual Springfield Sleepout
November 12th, 2010
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