To be completed by ALL adult members (18 years or older).

I hereby certify that I:

– am seeking case management services from Family Promise of Pierce County for Case Management, Shelter, or Housing Assistance.

– understand that Family Promise of Pierce County is unable to serve clients who are currently receiving case management services from other county-funded agencies.

– to the best of my knowledge, I am not currently receiving case management services from any other county-funded agency that duplicates the services provided by Family Promise of Pierce County.

– understand that if I am found to be receiving duplicate case management services, I may be ineligible to continue receiving services from Family Promise of Pierce County.