Forms > Homeless Verification Form

Homeless Verification Form

A homeless verification form is a document to prove that a certain individual is homeless and has no place to stay. This form is filled so that the individual gets a place to reside after referred by an agency.

Sample Homeless Verification Form:

Name of the individual: First name __________ Middle name _______ Surname _______

Name of person referring the individual: _________________________

Name of the referring Agency: ________________

I would like to inform that the person to whom I am referring is homeless. His daily residence includes:

Places unsuitable for human habitation like car parks, sidewalks and abandoned buildings.

He also sometimes resides in an emergency shelter:

Name of the shelter: ________

Address of the shelter: ___________________________

He was also residing in a mental institution for a period of thirty days. He has been discharged now, but has no means to obtain a shelter. Details of the mental institution:

Name: __________

Address: ____________________

_________________________________

Signature of Individual Making referral:

Dated: __________

________________________

Guest Signature

Dated: ____________

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