Housing Stability Assessment
Client Information
Name
Date
Assessment Completed By
Current Housing
Current Living Situation
Own Home
Renting
Staying with Friends/Family
Homeless/Shelter
Other
How long have you lived at your current address?
Number of Moves in Last 12 Months
Others living in the household
Housing Stability
Do you feel your housing is stable?
Yes
No
Unsure
If unstable or unsure, please explain
Have you received any eviction notices in the past year?
Yes
No
Are you able to pay your rent/mortgage on time?
Yes
No
Sometimes
Barriers & Strengths
Barriers to housing stability
Strengths or resources that help with housing
Additional Comments