Have you ever been Jail Jail Jail Jail Jail ⃝ ⃝ ⃝ ⃝ ⃝ in jail, prison, or Prison Prison Prison Prison Prison ⃝ ⃝ ⃝ ⃝ ⃝ juvenile hall? Juvenile Hall Juvenile Hall Juvenile Hall Juvenile Hall Juvenile Hall ⃝ ⃝ ⃝ ⃝ ⃝ No No No No No ⃝ ⃝ ⃝ ⃝ ⃝ Doesn’t Know Doesn’t Know Know Doesn’t Know Doesn’t Know ⃝ ⃝ ⃝ ⃝ ⃝ Refused Refused ⃝ Refused Refused ⃝ Refused ⃝ ⃝ ⃝ Have you ever Yes Yes Yes Yes Yes ⃝ ⃝ ⃝ ⃝ ⃝ served on active No No No No No ⃝ ⃝ ⃝ ⃝ ⃝ duty in the US Doesn’t Know Doesn’t Know Doesn’t Know Doesn’t Know Doesn’t Know ⃝ ⃝ ⃝ ⃝ ⃝ forces? Refused Refused Refused Refused Refused ⃝ ⃝ ⃝ ⃝ ⃝ going to ask you some specific questions about your housing history and services you are accessing. “I’m Please try to give me your best estimates.” Head of Household Person 2 Person 3 Person 4 Person 5 When did you become homeless this time? Doesn’t know Doesn’t know Doesn’t know Doesn’t know ⃝ ⃝ ⃝ ⃝ know [Ask for a specific date or ⃝ Refused Refused Refused Refused round to nearest month] ⃝ ⃝ Refused ⃝ ⃝ ⃝ 1 [only time] 1 [only time] 1 [only time] 1 [only time] 1 [only time] many times How ⃝ ⃝ ⃝ ⃝ ⃝ 2 2 2 2 2 have you been ⃝ ⃝ ⃝ ⃝ ⃝ homeless in the past 3 3 3 3 3 ⃝ ⃝ ⃝ ⃝ ⃝ three years? 4 or more 4 or more 4 or more 4 or more 4 or more ⃝ ⃝ ⃝ ⃝ ⃝ Doesn’t know Doesn’t know Doesn’t know know know [This only includes streets, ⃝ ⃝ ⃝ ⃝ ⃝ emergency shelters, or Refused Refused Refused Refused Refused ⃝ ⃝ ⃝ ⃝ ⃝ safe havens]
Have you ever been in jail, prison, or juvenile hall? ⃝ Jail ⃝ Prison ⃝ Juvenile Hall ⃝ No ⃝ Doesn’t Know ⃝ Refused ⃝ Jail ⃝ Prison ⃝ Juvenile Hall ⃝ No ⃝ Doesn’t Know ⃝ Refused ⃝ Jail ⃝ Prison ⃝ Juvenile Hall ⃝ No ⃝ Know ⃝ Refused ⃝ Jail ⃝ Prison ⃝ Juvenile Hall ⃝ No ⃝ Doesn’t Know ⃝ Refused ⃝ Jail ⃝ Prison ⃝ Juvenile Hall ⃝ No ⃝ Doesn’t Know ⃝ Refused Have you ever served on active duty in the US forces? ⃝ Yes ⃝ No ⃝ Doesn’t Know ⃝ Refused ⃝ Yes ⃝ No ⃝ Doesn’t Know ⃝ Refused ⃝ Yes ⃝ No ⃝ Doesn’t Know ⃝ Refused ⃝ Yes ⃝ No ⃝ Doesn’t Know ⃝ Refused ⃝ Yes ⃝ No ⃝ Doesn’t Know ⃝ Refused “I’m going to ask you some specific questions about your housing history and services you are accessing. Please try to give me your best estimates.” Head of Household Person 2 Person 3 Person 4 Person 5 When did you become homeless this time? [Ask for a specific date or round to nearest month] ⃝ Doesn’t know ⃝ Refused ⃝ Doesn’t know ⃝ Refused ⃝ Doesn’t know ⃝ Refused ⃝ Doesn’t know ⃝ Refused ⃝ know ⃝ Refused How many times have you been homeless in the past three years? [This only includes streets, emergency shelters, or safe havens] ⃝ 1 [only time] ⃝ 2 ⃝ 3 ⃝ 4 or more ⃝ Doesn’t know ⃝ Refused ⃝ 1 [only time] ⃝ 2 ⃝ 3 ⃝ 4 or more ⃝ Doesn’t know ⃝ Refused ⃝ 1 [only time] ⃝ 2 ⃝ 3 ⃝ 4 or more ⃝ Doesn’t know ⃝ Refused ⃝ 1 [only time] ⃝ 2 ⃝ 3 ⃝ 4 or more ⃝ know ⃝ Refused ⃝ 1 [only time] ⃝ 2 ⃝ 3 ⃝ 4 or more ⃝ know ⃝ Refused
2018-Working-Youth-Survey-1.docx