Application For Housing Assistance Form Page 7
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19Current circumstances
22. Are you homeless at the
Yes
No
Go to 23.
moment, such as living on
give details
the streets, in a squat or in
a car?
If yes, how long have
you been homeless?
How many times have you been
homeless in the past five years?
23. Do you have somewhere safe
Yes
No
Go to 24.
to stay tonight?
give details
If yes, how long can you stay there?
24. Are you seeking housing
Yes
No
Go to 25.
assistance because you need to
leave the place you are staying and
Mark one box below that best describes your situation.
you have nowhere else to live?
You are living in crisis, emergency or temporary
Attach documents that support
your answer. See item 13 on the
accommodation (for example a refuge or a motel)
Evidence Requirements
You are staying with friends or family, but they cannot provide
Information Sheet for details.
you with longer term accommodation
You are living in a boarding house or caravan park on a short
term basis, or you are leaving a boarding house or caravan
park because it is closing.
You have received a Notice of Termination or a Warrant of
Possession
You are leaving a hospital
You are leaving a mental health facility
You are leaving a disability support facility
You are leaving a rehabilitation facility
You are being released from a juvenile detention centre
You are being released from a gaol/correctional centre
You are under a community-based order (probation and parole)
You are leaving state care
You are experiencing mortgage stress (property owners only)
Other
give details
24a. When will you be leaving the place you
DD/MM/YYYY
are staying (if known)?
DH3001 04/15
Page 5 of 16
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