Edit, Download, and Sign the Long-Term Homeless Eligibility Verification Form
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How do I fill this out?
Filling out this form is straightforward. Start by providing your name and relevant housing history. Ensure that both you and a housing professional sign the form.

How to fill out the Long-Term Homeless Eligibility Verification Form?
1
Provide your print name clearly.
2
List your housing history for the last one to four years.
3
Select the type of living situation for each period.
4
Explain reasons if third-party verification isn't possible.
5
Sign and date the form.
Who needs the Long-Term Homeless Eligibility Verification Form?
1
Homeless individuals needing proof of status for housing assistance.
2
Social workers assisting clients with homelessness verification.
3
Housing providers requiring documentation for program eligibility.
4
Non-profits helping people transition to stable housing.
5
Government agencies verifying homelessness for funding purposes.
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1
Open the PDF in PrintFriendly.
2
Select the text or fields you wish to edit.
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Make necessary changes and corrections.
4
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5
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What are the instructions for submitting this form?
To submit this form, fax it to the number provided or email it directly to your housing provider. Ensure that all signatures are complete to avoid submission delays. For physical submissions, mail the form to the address listed in the instructions.
What are the important dates for this form in 2024 and 2025?
This form is effective from April 2015 and must be updated annually to reflect the most current housing status information.

What is the purpose of this form?
The purpose of this form is to assist individuals experiencing long-term homelessness in verifying their status. It serves as an essential document for accessing various housing programs and resources. By providing accurate housing history and required signatures, applicants can demonstrate their eligibility for assistance.

Tell me about this form and its components and fields line-by-line.

- 1. Print Applicant Name: Field for the applicant to write their full name.
- 2. Housing History: Section to detail the applicant's housing situations over a specified period.
- 3. Signature: Field for the applicant's signature for verification.
- 4. Housing Professional's Determination: Section for the housing professional to indicate eligibility confirmation.
- 5. Contact Information: Fields for the housing professional's contact details.
What happens if I fail to submit this form?
Failure to submit this form may result in delays in securing housing assistance. It is crucial for both the applicant and housing provider to have this documentation completed accurately.
- Delayed Assistance: Missing submissions can lead to prolonged periods without housing support.
- Ineligibility: Incomplete forms may result in individuals being deemed ineligible for housing programs.
- Legal Issues: Lack of proper documentation can complicate legal housing processes.
How do I know when to use this form?

- 1. Accessing Housing Support: Use this form to prove eligibility for housing assistance programs.
- 2. Proof for Social Services: This form can be necessary for securing social services designed for the homeless.
- 3. Documentation for Non-Profits: Non-profits may require this form to assist individuals in transitioning to permanent housing.
Frequently Asked Questions
What is the purpose of this form?
This form verifies long-term homeless status for individuals needing housing assistance.
How do I fill out the LTH eligibility form?
Provide your housing history, select living situations, and ensure signatures are included.
Can I edit this form on PrintFriendly?
Yes, you can easily edit the form using our user-friendly PDF editor.
How do I submit this form once completed?
Submit to your housing provider via fax or email as listed on the form.
Is third-party verification required?
It is preferred, but self-certification is allowed if third-party verification is not feasible.
What if I miss filling out a section?
Ensure all sections are completed to avoid delays in processing.
Can multiple episodes of homelessness be verified?
Yes, you can list multiple episodes within the required timeframe.
Who can assist me in filling out this form?
A housing professional or social worker can assist with this form.
What if I don’t have all my housing history?
Provide as much accurate information as possible, explaining gaps in the comments section.
Do I need a professional to sign off on the form?
Yes, a signature from a housing or service professional is required for verification.