Veteran’s Shelter Program Exit Interview
Participant Information
Name
Exit Interview Date
Caseworker
Reason for Exit
What is the primary reason for leaving the program?
Moved to permanent housing
Left voluntarily
Rule violation
Incarceration
Entering treatment program
Hospitalization
Other
If 'Other', please specify
Experience in Program
How would you rate your overall experience?
Excellent
Good
Fair
Poor
What services/support were most helpful?
What could we improve?
Future Plans
What are your current housing plans?
Are you currently employed or seeking employment?
Employed
Seeking Employment
Not Seeking Employment
What support do you feel you may need after leaving?
Additional Comments
Is there anything else you would like to share?