Hvrp Manual Sample Forms (Page 2 of 2) in pdf

Hvrp Manual Sample Forms Page 2

HVRP Manual Sample Forms

This a sample form and does not mean NVTAC or US DOL-VETS endorses this form as required, or as an approved form. This form was one of many that were

collected from service providers and is only intended to help program planners develop forms and tools that will serve the needs of their program.

To Be Certified by HVRP Staff

I have reviewed this applicant’s statement above and have secured necessary backup documentation

supporting this applicant’s homeless and veteran status. I certify this applicant’s stats as follows:

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Applicant meets eligibility for Veteran

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Applicant meets eligibility for Homeless Category 1 Literally Homeless

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Applicant meets eligibility for Homeless Category 2 – Imminent Risk of Homelessness

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Applicant meets eligibility for Homeless Category 3 – Homeless under other Federal statutes (provide

documentation)

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Applicant meets eligibility for Homeless Category 4 – Fleeing/Attempting to Flee Domestic Violence

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Applicant meets eligibility for Chronic Homelessness

__________________________________

______________________

HVRP Staff

Date

Hvrp Manual Sample Forms Page 2