Using the information given so far, please fill out a needs assessment. (Credit given to National Standardized Assessment Template for NAARS, off of which this form was adapted)

Initials of attending staff member (input your initials here) *

Please select up to 3 categories which represent the client/patient's greatest needs *

Basic Needs

Language and literacy

Employment opportunities and training

Health services

Family and children

Immigration aid

Legal aid

Consultation/reporting with law enforcement

Social and community supports

Mental health supports

Please identify up to 3 vulnerabilities the client/patient has experienced (currently or historically) For example: under 18, food insecurity, history of abuse, member of vulnerable group, etc. *

Thank you!

When prompted, click here to continue to the next section

Action Coalition on Human Trafficking (ACT) Alberta

PO Box 302 Station Main
Edmonton, AB T5J 2J6
MAIN: 780.474.1104
EMAIL: info@actalberta.org

ACT Alberta is a registered charity and non-profit organization operating under the Alberta Societies Act.
Charitable Registration #: 830548400 RR0001