Homeless Coalition of Hillsborough County

Housing Preferencesand Search Worksheet

Name:Phone Number

Please complete this form and help us understand what type of housing you desire, the location where you wish to live and any other preferences you have in selecting housing. Once completed, you will review the form with your case manager, who will complete the section at the bottom with you.

SECTION 1 – Your Housing Preferences

I prefer to live in the following type of housing: no preference an apartment

 house (single family) duplex boarding home assisted living

 other

My reason for selecting this type of housing is:

Described Preferred Location (area, zip code, neighborhood, etc.):

Reason for Choosing this Neighborhood:

1/3/13Page 1

 Near public transportation

 Near major roads/highways

 Near schools/daycare

 Near work

 Near healthcare and supportive services

 Near parks/play areas/public library

 Near family/friends

 Near grocery store & shopping

 Near religious and recreation facilities

 Safe

 Children can play outside

 Quiet

 Other:

 Other:

1/3/13Page 1

Additional Preferences (check all that apply; underline those amenities most important to you)

# of bedrooms needed: # of baths:

1/3/13Page 1

Air conditioning

Closets and storage

Dishwasher

Elevator

Handicap accessibility

 Microwave included

On quiet street

One level (no stairs)

 On-site laundry facilities

Secured entrance/gated community

 Single Building/Smaller Complex

Utilities included

Washer and dryer in unit/hook ups

 Where Pets are allowed*

Yard/playground

Other:

1/3/13Page 1

I understand that I may not be able to locate housing within my budget that meets all of my choices and preferences and/or is rent reasonable for the size of my household.

*Please note the SSVF program is not able to assist with pet deposits or additional rent charged for pets.

SECTION 2 – to be completed with your case manager

After reviewing the household’s preferences and housing barrier self assessment, please use the following information to help guide your housing search.

Number of people in the Household: _____ Adults_____ Children

Housing Unit Size: _____ bedroom(s)

Based on your household’s income (current/potential income in the near future), and budget, along with the general rental amount guidelines, it is recommended you look for housing within the following rent range:

$ ______to $ ______

Of the amenities listed in Section 1, you have identified the following as your 3 top needs

1.

2.

3.

The next three steps in your housing search are:

1.

2.

3.

For households with barriers to obtain housing, including but not limited to a formal court eviction in the last 3 years and/or criminal background, you may be connected to work directly with the SSVF housing specialist, Greg Williams.

If it is being recommended you work with Greg, your appointment to meet with him is:

______at ______a.m./p.m. at ______

(DATE)(TIME)(WHERE)

Veteran SignatureDate

Case Manager SignatureDate

1/3/13Page 1