Talked to police because you witnessed a crime, were the victim of a crime, or the Refused alleged perpetrator of a crime or because the police told you that you must move along? Stayed one or more nights in a holding cell, jail or prison or juvenile detention, whether Refused that was a short-term stay like the drunk tank, a longer stay for a more serious offence, or anything in between? Have you been attacked or beaten up since you’ve become homeless? Y N Refused Have you threatened to or tried to harm yourself or anyone else in the last year? Y N Refused Do you have any legal stuff going on right now that may result in you being locked up, Y N Refused having to pay fines, or that make it more difficult to rent a place to live? Were you ever incarcerated when younger than age 18? Y N Refused Does anybody force or trick you to do things that you do not want to do? Y N Refused Do you ever do things that may be considered to be risky like exchange sex for Y N Refused money, run drugs for someone, have unprotected sex with someone you don’t know, share a needle, or anything like that? C. Socialization & Daily Functioning Is there any person, past landlord, business, bookie, dealer, or government group like the Y N Refused CRA that thinks you owe them money? Do you get any money from the government, an inheritance, an allowance, working Y N under the table, a regular job, or anything like that? (get from #14 above) Do you have planned activities, other than just surviving, that make you feel happy Y N Refused and fulfilled? Are you currently able to take care of basic needs like bathing, changing clothes, using a Y N Refused restroom, getting food and clean water and other things like that? Is your current lack of stable housing… Because you ran away from your family home, a group home or a foster Y N Refused home? Because of a difference in religious or cultural beliefs from your Y N Refused parents, guardians or caregivers? Because your family or friends caused you to become homeless? Y N Refused Because of conflicts over gender identity or sexual orientation? Y N Refused Because of violence at home between family members? Y N Refused Because of an unhealthy or abusive relationship, at home or Y N Refused elsewhere? D. Wellness Have you ever had to leave an apartment, shelter program, or other place you were Y N Refused
Talked to police because you witnessed a crime, were the victim of a crime, or the alleged perpetrator of a crime or because the police told you that you must move along? Refused Stayed one or more nights in a holding cell, jail or prison or juvenile detention, whether that was a short-term stay like the drunk tank, a longer stay for a more serious offence, or anything in between? Refused Have you been attacked or beaten up since you’ve become homeless? Y N Refused Have you threatened to or tried to harm yourself or anyone else in the last year? Y N Refused Do you have any legal stuff going on right now that may result in you being locked up, having to pay fines, or that make it more difficult to rent a place to live? Y N Refused Were you ever incarcerated when younger than age 18? Y N Refused Does anybody force or trick you to do things that you do not want to do? Y N Refused Do you ever do things that may be considered to be risky like exchange sex for money, run drugs for someone, have unprotected sex with someone you don’t know, share a needle, or anything like that? Y N Refused C. Socialization & Daily Functioning Is there any person, past landlord, business, bookie, dealer, or government group like the CRA that thinks you owe them money? Y N Refused Do you get any money from the government, an inheritance, an allowance, working under the table, a regular job, or anything like that? (get from #14 above) Y N Do you have planned activities, other than just surviving, that make you feel happy and fulfilled? Y N Refused Are you currently able to take care of basic needs like bathing, changing clothes, using a restroom, getting food and clean water and other things like that? Y N Refused Is your current lack of stable housing… Because you ran away from your family home, a group home or a foster home? Y N Refused Because of a difference in religious or cultural beliefs from your parents, guardians or caregivers? Y N Refused Because your family or friends caused you to become homeless? Y N Refused Because of conflicts over gender identity or sexual orientation? Y N Refused 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 D. Wellness Have you ever had to leave an apartment, shelter program, or other place you were Y N Refused