A homeless verification form is a document to prove that a certain individual is homeless and has no place to stay. This form is filled so that the individual gets a place to reside after referred by an agency.
Sample Homeless Verification Form:
Name of the individual: First name __________ Middle name _______ Surname _______
Name of person referring the individual: _________________________
Name of the referring Agency: ________________
I would like to inform that the person to whom I am referring is homeless. His daily residence includes:
- Places unsuitable for human habitation like car parks, sidewalks and abandoned buildings.
- He also sometimes resides in an emergency shelter:
Name of the shelter: ________
Address of the shelter: ___________________________
- He was also residing in a mental institution for a period of thirty days. He has been discharged now, but has no means to obtain a shelter. Details of the mental institution:
Signature of Individual Making referral: