Rapid Rehousing Homeless Verification Form
Applicant Information
Full Name
Date of Birth
Client ID (if applicable)
Contact Number
Email Address
Current Living Situation
Current Address/Location
Describe current living conditions
Date Became Homeless
Homeless Status Verification
Type of Homelessness
Currently in Emergency Shelter
Unsheltered (e.g., street, car)
Transitional Housing
Other
Name of Person Verifying Status
Agency/Organization
Date of Verification
Additional Notes
Comments