Homeless Assessment Form

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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 probation order? *

Are you recently discharged from the Armed Service 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? *

Please indicate whether you can be contacted by phone. If you do not have a telephone number we can contact you on, please select 'No'. However you must then go to The Hive to see a housing officer as we will not be able to contact you. When you speak to a member of staff at The Hive please advise them that you have already completed this online form.