CONNECTION WITH SOAR of Households and Adults, not required for HUD VASH or GPD] No Client doesn’t know ○ ○ Client refused ○ Yes ○ Data not collected ○ LAST GRADE COMPLETED [Head of Household & Adults,not required for GPD] Less than Grade 5 Grades 5-6 ○ ○ Grades 7-8 Grades 9-11 ○ ○ Grade 12 School does not have grade levels ○ ○ GED Some college ○ ○ Associate’s Degree Bachelor's degree ○ ○ Graduate Degree Vocational certification ○ ○ Client doesn't know ○ Data not collected Client refused ○ ○ EMPLOYMENT STATUS of Household, Adults, HUD-VASH OTH only] Employed No Client doesn’t know ○ ○ Client refused ○ Yes ○ Data not collected ○ If for employed Type of employment “Yes” – ○ Seasonal/sporadic (including day ○ ○ If for employed Why not employed “No” – ○ Looking for work Not looking for work ○ ○ Unable to work GENERAL HEALTH STATUS of Household, Adults, HUD-VASH OTH only] Excellent Poor ○ ○ Very good Client doesn’t know ○ ○ Good Client refused ○ ○ Fair Data not collected ○ ○ LAST PERMANENT ADDRESS of Household and Adults, not required for GPD] Street Address City State Zip Code QUALITY OF ADDRESS Full address reported Client doesn’t know ○ ○ Client refused ○ Partial, street name, or code name reported ○ Data not collected ○
CONNECTION WITH SOAR of Households and Adults, not required for HUD VASH or GPD] ○ No ○ Client doesn’t know ○ Yes ○ Client refused ○ Data not collected LAST GRADE COMPLETED of Household & Adults,not required for GPD] ○ Less than Grade 5 ○ Grades 5-6 ○ Grades 7-8 ○ Grades 9-11 ○ Grade 12 ○ School does not have grade levels ○ GED ○ Some college ○ Associate’s Degree ○ Bachelor's degree ○ Graduate Degree ○ Vocational certification ○ Client doesn't know ○ Data not collected ○ Client refused EMPLOYMENT STATUS of Household, Adults, HUD-VASH OTH only] Employed ○ No ○ Client doesn’t know ○ Yes ○ Client refused ○ Data not collected If “Yes” for employed – Type of employment ○ ○ Seasonal/sporadic (including day ○ If “No” for employed – Why not employed ○ Looking for work ○ Not looking for work ○ Unable to work GENERAL HEALTH STATUS of Household, Adults, HUD-VASH OTH only] ○ Excellent ○ Poor ○ Very good ○ Client doesn’t know ○ Good ○ Client refused ○ Fair ○ Data not collected LAST PERMANENT ADDRESS of Household and Adults, not required for GPD] Street Address City State Zip Code QUALITY OF ADDRESS ○ Full address reported ○ Client doesn’t know ○ Partial, street name, or code name reported ○ Client refused ○ Data not collected [Head
VA-combined-Project-Intake-HMIS-2017-rev14Sept17.docx