Please explain connections: Please note if you have a need or a Need Preferred Notes preference for each of the following. Cultural or population specific housing (tribal, HIV/AIDS, LBGT) Site GRH Have a Front Desk Mobility/Access Access to public transportation Safety Scattered Site Stay enrolled in same school district Sober Housing/Treatment based Contact Information: Contact Name Relationship Phone Email Notes Current Case Workers/Providers that you are working with: PROVIDER AGENCY WORKER EMAIL PHONE NOTES TYPE Opening Script my name is [interviewer name] and I work for [organization name]. To determine your eligibility for homeless services, I would like to assess your housing and service needs. If you give me permission, I will ask you questions about your health and housing. The assessment will take about 15 minutes. Some of the questions will ask personal questions, but only require yes or no answers. The questions are not intended to judge you, but to assess your current needs and eligibility for services. If you ask, I can clarify or you can decide not to answer a question. If you do not answer a question, no one will be upset with you. However, this information is important to help determine if you qualify for services. Skipped or inaccurate answers may affect your eligibility. It will benefit you to answer as honestly as possible, especially since we may need to verify some of your answers later.
Please explain connections: Please note if you have a need or a preference for each of the following. Need Preferred Notes Cultural or population specific housing (tribal, HIV/AIDS, LBGT) Site GRH Have a Front Desk Mobility/Access Access to public transportation Safety Scattered Site Stay enrolled in same school district Sober Housing/Treatment based Contact Information: Contact Name Relationship Phone Email Notes Current Case Workers/Providers that you are working with: PROVIDER TYPE AGENCY WORKER EMAIL PHONE NOTES Opening Script my name is [interviewer name] and I work for [organization name]. To determine your eligibility for homeless services, I would like to assess your housing and service needs. If you give me permission, I will ask you questions about your health and housing. The assessment will take about 15 minutes. Some of the questions will ask personal questions, but only require yes or no answers. The questions are not intended to judge you, but to assess your current needs and eligibility for services. If you ask, I can clarify or you can decide not to answer a question. If you do not answer a question, no one will be upset with you. However, this information is important to help determine if you qualify for services. Skipped or inaccurate answers may affect your eligibility. It will benefit you to answer as honestly as possible, especially since we may need to verify some of your answers later.
VI-SPDAT-MN-Youth_LockedFillable.docx