Multigenerational Household Needs Assessment
Household Information
Household Name
Total Number of People
Address
Household Composition
List each household member (age, relationship, special needs or considerations)
Current Housing Situation
Describe current living arrangements (rooms, facilities, privacy)
Daily Living Needs
Childcare/Eldercare requirements
Transportation needs
Meal preparation and food needs
Health and Wellness
Medical or mobility concerns
Medication or equipment needs
Mental health or emotional support needs
Financial Considerations
Main sources of income
Major expenses
Assistance currently received
Additional Comments or Needs