Veterans Justice Project

Veteran's Name:

Shelter/Housing location

Branch Served:

Current housing status:

Unsheltered/street

Couch surfing

Sleeping in car

Shelter (SRO, hotel, veterans)

Housing goals:

Stay in NYC (Five boroughs)

New York State

Tri-State Area (NY, NJ, CT)

Will relocate for better opportunity

Seeking Supportive Housing

Preferred living situation:

Is the veteran enrolled in:

NYCHRA (EBT)

NYCHA (Housing)

Housing voucher (in hand):

CityFHEPS voucher

HASA voucher

Section 8 voucher

HUD/VASH voucher

Reason for homelessness

Because of natural disaster (fire, flood, etc)

Because of financial (bankruptcy, loss of income, employment)

Eviction (Criminal damage, arrest, rent)

To care for a loved one

New employment opportunity

Judicial (jail, prison, halfway house)

Relocation from the NYC area

Relocation from the tri-state area

Relocation from outside New York State

Number of times homeless last ten years:

1

2

3+

Length of last homelessness:

60 days

2 to 6 months

6 months to year

One year or more

How long at current housing (shelter, couch surfing, other shelter):

60 days

2 to 6 months

6 months to year

One year or more

Number in family

Marital status:

Household pets

Companion animal

Service animal

Combat K

Veteran's Housing Questionnaire (Check All That Apply)