Assessment Tool:
Family Housing Connection (FHC) is a program for families, including expectant families, who are in need of shelter or housing in King County. FHC offers an organized, efficient approach that connects families with services and housing by creating streamlined linkages to more than 80 programs based on needs identified by families.
The purpose of this assessment is to get to know your family better. Learning about your housing needs and preferences will help us identify housing options in King County that may be a good fit for your family. Programs participating in FHC include emergency shelter, voucher programs, rental assistance, transitional housing and permanent supportive housing programs. Confidentiality is very important to us. The answers you provide will only be shared with the program or programs your family is referred to. We cannot share this information without a signed Release of Information from you. Are you willing to sign a Release of Information so we can refer you to a housing program when an opening becomes available?
Also, we input demographics and information we collect into a secure database, the Homeless Management Information System (HMIS). This helps us get an accurate count of the people experiencing homelessness in King County and the services that are provided, leading to advocacy for additional resources.
We do not make assumptions and ask each question of every family. Thank you for your patience if an answer feels obvious or repetitive.
Contact/Identifying Information – for all household members
Beginning with yourself, please provide the following information for each member of your household:
a. Full name (including what you would like to be referred to) or AliasDate of birth
b. How do you identify your gender? (Male, Female, Transgender Male to Female, Transgender Female to Male)
c. What is the best way to contact you? Do you have an alternate number we can use in case we cannot reach you at this number? Do you have a reliable email address that we may email you at?
1. How many people do you anticipate living in your household?
2. Is anyone in your household currently pregnant?
3. What is your family size?
4. Has Child Protective Services been involved with anyone in your household throughout the last 12 months?
5. Are any children in your family temporarily or permanently out of your home due to loss of custody (not just staying with a helpful friend or family member)? If temporary, do you know the expected date for reunification?
Housing Background /Homelessness
Current Living Situation: Please tell me about your current living situation:
a. Where did your family stay last night?
b. Do you know the zip code of this location? If not, what city did you stay in?
c. Do you know where you will stay tonight?
d. How long do you feel your family would be able to stay at this location? Do you have any other locations (i.e. friends or family) that you feel you may be able to spend some time with?
e. What would you set as the date your family became homeless?
f. Is this your family’s first experience without having a consistent place to stay? If not, how many times has your family been without a place to stay?
Housing/ Rental history
a. Have you ever rented or owned an apartment or house? If so, did you lease or own in your name?
b. Do you feel you could get a positive landlord reference?
c. Have you ever been asked to leave your housing for any reason including eviction, foreclosure etc.? If yes, please explain.
d. Does your family owe any amount of rent to landlords or Housing Authorities? Have you discussed a payment plan?
e. Are you aware of any outstanding debt you may owe to utility companies? If yes, do you have a general idea of how much you owe?
f. Does your family currently have access to a Section 8 housing voucher?
Employment/Education – asked of all adults
a. How many years of school have you completed? Did you receive a diploma, GED or other certificate?
b. (If applicable) How many years of school did another adult in the household complete?
c. Are you currently employed? If yes, how long have you worked at your current job? Is this full/part/seasonal or temporary work? If no, what is the most recent job you’ve held?
d. (If applicable) Is another adult in your household employed? If yes, how long have you worked at your current job? Is this full/part/seasonal or temporary work? If no, what is the most recent job you’ve held?
e. Please tell me about your employment history. How many jobs have you had in the last five years? What is the longest time you’ve been employed with one company?
f. Have you ever served in the United States military?
c. Some programs receive funding that requires participants to have permanent right of residence in the United States. Not all programs have this requirement. Are you interested in being referred to a program that requires a permanent right of residence?
d. Do you speak any other languages besides your primary language?
Income/Financial
a. How much income does your household expect this month? Do you receive any income from sources such as employment wages, SSI or TANF? If unemployed, are you receiving unemployment insurance?
b. What is the average annual income in your household?
c. Do you expect any changes in your household income in the next month? Please explain.
d. If you are receiving TANF, do you expect any changes to this benefit in the near future?
e. Are you aware of any outstanding debt including credit cards, hospital/medical bills, car loans, school loans, etc. How much would you estimate you currently owe?
Criminal Background – asked of all adults
Many programs run a background check, so it’s helpful if you’re up front about anything they may find. Being honest about your criminal background is helpful to us so we can identify possible housing options and avoid referring you to options that you will not qualify for.
a. Do you or any of your household members currently have pending charges or upcoming court dates?
b. Has anyone in the household registered as a sex offender or are charges currently pending?
c. Does anyone in the household have any prior convictions for methamphetamine production or are charges currently pending?
d. Please tell me about your criminal background and what might be found on a background check.
If minor child: Does your child have a criminal record, pending charges or upcoming court dates?
Additional Services
Housing Preferences- It is helpful for us know more about your housing preferences and the services that may be available. Please keep in mind that it may not be possible to accommodate all of your preferences, but we will do our best and will communicate with you as resources become available.
a. Is your family interested in support services as part of your housing community? To give you an idea of what may be available, some options are:
· Domestic Violence Services
If Yes:
a. Are you currently experiencing a safety risk due to domestic violence?
b. Do you require confidential housing due to safety concerns?
c. In the case of domestic violence or other situations, are there areas that are unsafe for your family to live?
· Mental Health or Behavioral Health
· Education & Employment
· Substance Abuse
· Refugee & Immigrant Focused Services
· Culturally Tailored Services
· Veteran’s Support
· Pregnancy Support
· Other:
b. Are you interested in being referred to a program that requires someone in your household to have a disability?
c. Would your family want or need special accommodations in housing? This might include support for:
· Ramps for use of a wheelchair in and outside your home
· Lack of mobility/you being less able to move around your home
· Serious hearing loss
· Serious loss of vision
· Other (please give details) ______
d. We understand that families have connections to specific communities in King County and it is important that your family specify the connections that are important to you. Is there a specific area in King County that you would prefer to live? Can you please explain why so we fully understand?
e. If housing or shelter is not available in your preferred area, would you be interested in housing programs in other locations? Please understand that specific preferences will likely result in your family waiting longer for housing due to limited resources, unless you want to be considered for most or any resource that becomes available.
f. Does your household currently have a family pet that is not a service animal?
i. Is there anything else that you’d like us to know regarding your housing needs?
The following questions are completely voluntary and used for statistical purposes only. Family Housing Connection is committed to providing an equitable service to all families. Providing us with this information will help us in determining whether our current system serves families equally.
a. Of the following, how would you identify your race (you may choose more than one) – American Indian or Alaskan Native, Black or African American, Asian, Native Hawaiian or Pacific Islander, White, or Other?
b. What is your ethnic origin? Do you consider yourself Hispanic or Latino?
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