HomeMy WebLinkAboutverification-of-literal-homelessness-letter-r
Contact HOME STRETCH
fax: 1 (855) 658-5466, email: HomeStretch@acgov.org, phone: (510) 567-8017
v. 6 - Effective 5/8/19
Verification of Literal Homelessness Letter Template
***IMPORTANT, PLEASE READ***
Please provide verification of homelessness on your agency letterhead. The recommended template below
may be copied onto letterhead or recreated with the same content and printed on letterhead. Please
complete separate verification letters for each episode of homelessness, as required by HUD.
This verification of homelessness will help prioritize chronically homeless and disabled individuals for permanent supportive housing
opportunities in Alameda County.
I certify that (Client’s Name)
stayed at _______________ ______ (Location/Facility/Program Name)
for the following period of time: between and .
Month/Day/Year Month/Day/Year
This location/facility/program is classified as one of the following types:
Place not meant for human habitation (e.g., vehicle, abandoned building, bus/train/subway station/airport or
anywhere outside)
Emergency Shelter (including hotel or motel paid for with an emergency shelter voucher)
Transitional Housing
Hospital or other residential non-psychiatric medical facility
Psychiatric hospital or other psychiatric facility
Jail, prison or juvenile detention facility
Substance use disorder treatment facility or detox center
A house or home, from which client is currently fleeing to escape domestic violence
Other (please specify): ___________________________________________________________________
Before coming to the location listed above, this client resided at: ________________________________________
____________________________________ for _______ (# of) months, between _____ and __ ______ .
Month/Day/Year Month/Day/Year
I also certify that this client currently has no other housing options and lacks other networks or resources to secure
housing.
Name of Staff Member (Print): _____________
Title of Staff Member: ___Staff Phone Number: ___________________
Staff Member Signature: Date Signed: _______