Because of violence at home between family Y N Refused members? Because of an unhealthy or abusive relationship, at Y N Refused home or elsewhere? 1 D. Wellness Have you ever had to leave an apartment, shelter Y N Refused program, or other place you were staying because of your physical health? Do you have any chronic health issues with your liver, Y N Refused kidneys, stomach, lungs or heart? Do you have any physical disabilities that would limit the Y N Refused type of housing you could access, or would make it hard to live independently because you’d need help? When you are sick or not feeling well, do you avoid Y N Refused getting help? Are you currently pregnant, have you ever been Y N N/A pregnant or have you ever gotten someone pregnant? Or Refused 1 “YES” Has your drinking or drug use led you to being kicked Y N Refused out of an apartment or program where you were staying in the past? Will drinking or drug use make it difficult for you to stay Y N Refused housed or afford your housing? If you’ve ever used marijuana, did you ever try it at age Y N Refused 12 or younger? 1 “YES”
Because of violence at home between family members? Y N Refused Because of an unhealthy or abusive relationship, at home or elsewhere? Y N Refused 1 D. Wellness Have you ever had to leave an apartment, shelter program, or other place you were staying because of your physical health? Y N Refused Do you have any chronic health issues with your liver, kidneys, stomach, lungs or heart? Y N Refused Do you have any physical disabilities that would limit the type of housing you could access, or would make it hard to live independently because you’d need help? Y N Refused When you are sick or not feeling well, do you avoid getting help? Y N Refused Are you currently pregnant, have you ever been pregnant or have you ever gotten someone pregnant? Y N N/A Or Refused “YES” 1 Has your drinking or drug use led you to being kicked out of an apartment or program where you were staying in the past? Y N Refused Will drinking or drug use make it difficult for you to stay housed or afford your housing? Y N Refused If you’ve ever used marijuana, did you ever try it at age 12 or younger? Y N Refused “YES” 1