Pbv Application Packet - Housing Authority Of Snohomish County Page 17
ADVERTISEMENT
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38HOUSING AUTHORITY OF SNOHOMISH COUNTY
Avenue West, • Everett, Washington 98204
th
12711 - 4
PHONE (425) 290-8499• FAX (425) 290-5618
HOMELESS STATUS
Please answer the following questions:
1. Are you currently living in a car, on the street, or another place not meant for
human habitation?
YES☐ NO☐
2. Are you currently living in an emergency shelter, transitional housing, Safe
Haven, or a hotel/motel paid for by a charitable organization or by federal,
state or local government programs for low-income individuals?
YES☐ NO☐
3. If you are exiting an institution, including a hospital, substance abuse or
mental health treatment facility, or jail/prison, where you stayed for 90 days
or less, were you living in an emergency shelter or place not meant for human
habitation immediately before entering that institution?
YES☐ NO☐
4. If you are fleeing or attempting to flee domestic violence, dating violence,
sexual assault, stalking, or other dangerous or life threatening conditions for
you or a family member, including a child, that has either taken place within
your family’s primary nighttime residence or has made you afraid to return to
your primary nighttime residence, do you currently have nowhere else to live
and also lack the resources or support networks, including family, friends,
faith-based or other social networks, to obtain other permanent housing?
YES☐ NO☐
Equal Housing Opportunity
ADVERTISEMENT
0 votes
Related Articles
Related forms
Direct Deposit Authorization Agreement Form - Housing Authority Of The City & County Of Denver
Legal
Ead For J -2 Dependent Application Packet - The University Of South Alabama Office Of International Education
Legal
Form S504-02 - Housing Authority Of The City Of Los Angeles Reasonable Accommodation Questionnaire
Life
Form Aa-5 - Application For And Authorization Of Temporary Involuntary Hospitalization - Massachusetts Department Of Mental Health
Legal
Related Categories
Parent category: Legal