VHRC Housing Goals Progress
Vermont Homelessness Response Continuum
Date
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Month
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Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Client Name (Head of Household)
*
First Name
Last Name
Client Date of Birth
*
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Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Additional Household Member Name 1
First Name
Last Name
Additional Household Member Name 2
First Name
Last Name
Additional Household Member Name 3
First Name
Last Name
Additional Household Member Name 4
First Name
Last Name
Additional Household Member Name 5
First Name
Last Name
Additional Household Member Name 6
First Name
Last Name
Additional Household Member Name 7
First Name
Last Name
Additional Household Member Name 8
First Name
Last Name
Additional Household Member Name 9
First Name
Last Name
Additional Household Member Name 10
First Name
Last Name
Name of person filling out form
First Name
Last Name
Agency/Entity of person filling out form
*
Date of last meeting with client
*
/
Month
/
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Has there been any progress towards housing goals?
*
Yes
No
If there has been no progress, please explain why:
Housing Plan Goal for Which Progress Was Made
*
Vitals & Documentation
Natural Supports
Community Partner Supports
Coordinated Entry
Shelters
Residential Placements/Nursing Homes
Housing Applications
Other Barriers to Housing
Increase Income
Rentability
What progress was made towards goal(s)
*
Next goal(s)/action steps
*
Next Meeting Date
*
/
Month
/
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Submit
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