Homeless Experience Survey Homeless Survey Newsletter If you were homeless for a week or longer at any point of your life, we would appreciate your participation in this short survey. The purpose of this survey is to: Learn about the causes of homelessness Determine what services homeless people need Figure out what the greatest challenges are for homeless people Identify gaps and limitations in services and resources available Discover how people escape homelessness Collect advice and testimonies that can be shared with today's homeless population Please fill out this survey to the best of your knowledge. It will probably take up to 20 minutes or so, depending on your responses and how much information you choose to provide us. Most fields are optional, but the more detail you can provide, the better.PreviousNextContact InformationFirst Name (or desired alias if you wish to be anonymous)Last NameEmailPreviousNextTell Us About Your Homeless Experience Please share with us details about when you were homeless. In the textboxes that follow, you can provide as much detail as you are comfortable with sharing. If you were homeless multiple times, please share tell us so below, but focus on the most recent time.Are you... Male Female Prefer Not to AnswerHow old were you when you were homeless? Under 18 18-24 25-34 35-44 45-54 55-64 65 or Above Prefer Not to AnswerDid you have children at the time? Yes No Prefer Not to AnswerWere your children homeless with you? Yes No Prefer Not to AnswerWhen and where were you homeless?What led to you being homeless? How long were you homeless for? A week 2 weeks Less than a month 1-6 months 6-12 months 1-2 years 2-3 years Over 3 years Prefer Not to AnswerWhere did you spend your time during the day?How did you spend your time? Please describe.Where did you go at night?How did you escape homelessness?PreviousNextWhat kinds of challenges did you have to deal with at that time?Did you have a physical disability? Yes No Prefer Not to AnswerDid you have a serious health condition? Yes No Prefer Not to AnswerWere you struggling with drug addiction? Yes No Prefer Not to AnswerWere you struggling with depression, anxiety, or some other mental impairment? Yes No Prefer Not to AnswerWere you suicidal or have you had suicidal thoughts? Yes No Prefer Not to SayWere you a victim of physical abuse? Yes No Prefer Not to AnswerWere you a victim of sexual abuse? Yes No Prefer Not to AnswerWere you a convicted felon? Yes No Prefer Not to AnswerPlease describe any special needs or particular challenges you had at the time that would have negatively impacted your ability to seek or receive assistance, or that would have contributed to your situation.Were you intimidated, arrested, or forced to leave a location by law enforcement due to homelessness? If so, please tell us about your experience.PreviousNextTell Us About The Help You Received and What You LackedWhat kind of assistance did you receive while you were homeless?Where was the assistance located and how did you get there?What assistance did you lack?What kinds of assistance were available that you were aware of?What barriers prevented you from receiving certain kinds of assistance you needed?Were you denied assistance that you applied for? If yes, why were you denied.Have you ever stayed at a shelter? If so, please tell us about your experience. Did you ever refuse to go to a shelter or receive assistance? If so, why?PreviousNextGiven Your Experience, We Would Love to Hear What You ThinkWhat do you think non-profits, ministries, churches, and communities should be doing to help the homeless?Why do you think some homeless people refuse assistance?What advice would you like to give to those offering services to help the homeless?What advice would you like to give to those who are struggling with homelessness right now?Do you have any words of wisdom, inspiration, or hope that you would like to share with homeless people?PreviousNextIf there is anything else you would like to share, please feel free to share it below.May be publish quotes from your responses on our website and materials? Yes Yes, but get my approval first No Previous Submit
