I was comfortable answering
I was uncomfortable answering
How long has it been since you lived in your own place?
How many months have you been without a home, such as living outside or in a shelter?
Where did you sleep last night?
Where are you going to sleep tonight?
Have you ever been involved in the justice system (even if it was not true) and did that make it difficult to find housing? (Justice involved means being arrested, in jail, in prison, or on probation.)
Did you leave your previous or current living situation because you felt unsafe?
Have you experienced violence since becoming homeless?
Have you ever experienced violence with someone close to you?
Are you currently experiencing or feel you are at risk of experiencing violence?
Does anyone in your household have any physical or mental health conditions that are treated or have been treated by a professional?
Do you or does anyone in the household have lung cancer, kidney or liver failure, heart disease, or a substance use disorder?
Is the lack of housing making it hard to get to a doctor’s office or take prescribed medications?
Do you have health insurance?
What is the date of birth of all family members?
Is anyone in the household pregnant?
How many children under 18 are not currently staying with your family, but would live with you? (if you have a home)
How many adults 18 or older are not currently staying with your family, but would live with you? (if you have a home)
