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Homeless Verification Form Template

Create Your Essential Homeless Verification Letter Easily

Struggling to secure housing benefits due to documentation challenges? This homeless verification form template is designed to help individuals demonstrate their eligibility for housing aid effectively. With this straightforward tool, you can quickly create a compliant letter that supports your case, saves time in application processes, ensures you meet verification requirements, and ultimately helps you access vital services. Explore how this template can simplify your documentation efforts and assist you in gaining the support you need.

Use this Template (FREE) Live Preview
Applicant full name
Date of birth
Preferred contact phone (if available)
Email address (if available)
Is it safe for us to leave a voicemail or message at this number?
Yes
No
Not applicable
Current living situation
Street or place not meant for habitation (e.g., vehicle, encampment)
Emergency shelter
Transitional housing
Temporarily staying with friends or family (couch surfing)
Hotel/motel paid by self
Hotel/motel paid by agency or voucher
Institution (hospital, jail) less than 90 days with prior residence homeless
Prefer not to say
Other
Please Specify:
If other living situation, please describe
Current city and state
How long have you been in your current homeless situation?
Less than 1 week
1-4 weeks
1-3 months
3-12 months
More than 1 year
Prefer not to say
Household composition (select all that apply)
Are any dependents under 18 with you?
Yes
No
Prefer not to say
Agency or organization name
Verifier full name and role/title
Verifier phone
Date of contact or observation
Method(s) of verification
In-person observation
Phone interview with applicant
Applicant self-certification
Third-party statement
HMIS or record review
Other
Please Specify:
If third-party statement was used, what is the relationship to the applicant?
Service provider
Family member
Friend or acquaintance
Landlord or property manager
Employer
Not applicable
Other
Please Specify:
Location observed or reported (address, cross streets, or description)
Notes or observations relevant to verification
Eligibility criteria believed to be met (select all that apply)
Literally homeless (place not meant for habitation)
Staying in emergency shelter
Fleeing or attempting to flee domestic violence
Imminent risk of homelessness within 14 days with no subsequent residence identified
Long-term or repeated episodes of homelessness (chronic)
Number of homelessness episodes in the past 3 years
0
1
2-3
4 or more
Unknown
Disabling condition indicated by applicant
Yes
No
Prefer not to say
I consent to share my information with participating service providers solely for the purpose of housing and related services.
Strongly disagree
Disagree
Neither
Agree
Strongly agree
May we contact you about housing and services?
Yes
No
Applicant printed name
Applicant signature date
Verifier printed name
Verifier signature date
I certify that the information provided is true and correct to the best of my knowledge.
True
False
Age group
Under 18
18-24
25-34
35-44
45-54
55-64
65+
Gender identity
Woman
Man
Non-binary
Prefer to self-describe
Prefer not to say
Veteran status
Yes
No
Prefer not to say
Primary language
Preferred contact method
Phone call
Text message
Email
In-person via agency
No contact preferred
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Paper art illustration depicting a homeless verification form template for FormCreatorAI article

When to use this form

Use this form to document a person's lack of stable housing so they can access services, enroll children in school, or apply for benefits. Caseworkers, shelter staff, and landlords can capture dates, locations, and a signature to satisfy agency requirements. It is helpful when a family is sleeping in a car, couch-surfing, or staying at a shelter and needs proof for intake or a rental application. If you are asking where can I get a homeless verification letter online, this form creates a clear record you can submit. When screening an applicant, pair it with the Residency application form and the Tenant info form to keep files complete. If move-in fees are a barrier, coordinate with a Security deposit waiver form.

Must Ask Homeless Verification Questions

  1. What is your current living situation, and where do you stay most nights?

    This pins down the category (shelter, car, street, or couch-surfing) that many programs require. It also gives outreach teams a safe way to contact you for services or documentation.

  2. When did your housing instability begin, and has it been continuous?

    Length and continuity affect eligibility and priority. Clear dates help agencies confirm need without guesswork.

  3. Who can confirm your situation (caseworker, shelter staff, or community contact) and how can we reach them?

    A third-party verifier speeds approvals and reduces back-and-forth. Including a phone or email lets reviewers validate details fast.

  4. Will you apply alone or with a roommate or family member?

    Household makeup impacts space, income rules, and documentation. If you plan to share housing, ask each adult to complete a Roommate application form.

  5. What income or benefits do you receive, and what monthly rent can you afford?

    These details help match you with units and supports you can sustain. If you are approved, a Rent schedule form can outline deposits, assistance, and payment timing.

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