Assessment

Step 1 of 12

Initial Assessment

The purpose of this initial assessment is to gather basic information about your current situation so that we can determine whether there may be a funding source or services available that fit your needs. Because each funding program has specific eligibility requirements, this step helps us identify the most appropriate options available to you.

Providing complete and accurate information will allow us to review your circumstances efficiently and follow up with you regarding potential assistance.

Are you currently experiencing or fleeing from domestic violence?(Required)

Yes

The following agencies can assist you with safety and in being assessed for housing programs.

Citrus County: CASA 352-344-8111
Hernando County: Dawn Center 352-686-8430
Lake & Sumter County: The Haven 352-753-5800

What County are you in currently?(Required)

Citrus

Hernando

Lake

Sumter

Other

At this time it appears you do not qualify for any available funding, however, you may return to this page if your circumstances change. For additional resources local to your area, click on the link located below.

Florida Coalition to End Homelessness

Are you currently staying in a: streets, vehicles, tents, shed, woods, emergency shelter, or a motel paid for by a non-profit agency, church or government?(Required)

Yes

Do you currently need assistance with late rental or mortgage payments, or have you received a 7-day, 5-day or 3-day notice from your landlord/mortgage company?(Required)

Yes

HOMELESS ASSESSMENT

Name(Required)

First Last

Phone(Required)

Where did you sleep last night?(Required)

Where will you sleep tonight?(Required)

Is anyone in your household currently pregnant?(Required)

Yes

Have you or anyone in the household been to jail?(Required)

Yes

Have you or anyone in your household been to prison?(Required)

Yes

Have you been evicted?(Required)

Yes

How many times have you been evicted?(Required)

Are you a US Citizen?(Required)

Yes

Do you have any special needs, like physical disabilities, developmental disabilities, chronic health conditions, mental health illness, substance use or HIV/AIDS?(Required)

Yes

HOMELESS PREVENTION ASSESSMENT

Name(Required)

First Last

Phone(Required)

Are you a US Citizen?(Required)

Yes

What is the reason you need help at this time?

What assistancre do you need?(Required)

Rent

Mortgage

Utilities

Deposits

Other

What is your family composition?(Required)

Single Adult

Household with adults only

Household with children (under 18 yrs)

Total number of people in current household?(Required)

Do you have a 12-month lease(Required)

Yes

What is the current amount due?

How many months are currently owed?

Have you received a late notice?(Required)

Yes

What is the current monthly household income?

Citrus Hernando Lake Sumter Other