Homeless Assessment Form

Please note questions marked with an asterix (*) require an answer

Type of Tenure *

Would you consider yourself to have a disability? *

Do you have a serious, ongoing medical condition? *

Are you known to the Community Mental Health Team? *

Have you been released from a custodial sentence within the last month? *

Are you on a rehabilitation order or probabtion order? *

Are you recently discharged from the Armed Services and/or have you been a member of the Armed Forces? *

Have you ever been in care? *

Are you expecting a baby? *

Have you approached Worcester City Council Homeless or Advice before? *

Are you registered on Home Choice Plus? *

Are you completing this at The Hive? *