Homeless Survey Template: Rental/Utility Assistance

The Rental and Utility Assistance survey template helps organizations evaluate how effectively their emergency financial assistance programs are preventing eviction and utility shutoffs for households in crisis.

Rental and utility assistance is one of the most direct tools available to keep people in their homes. A single month of unpaid rent or a disconnected utility can quickly cascade into eviction, job loss, and homelessness. For families and individuals already living on the financial margin, timely emergency assistance can mean the difference between stability and crisis.

This survey template captures participant feedback on the ease of the application process, speed of assistance delivery, adequacy of the amount provided, and whether the program addressed the root issue. It also measures whether participants felt treated with respect and whether they understand how to access assistance again if needed.

Use this template to identify bottlenecks in your application and disbursement process, demonstrate to funders the speed and impact of your interventions, and track whether participants are successfully stabilized after receiving assistance. The ultimate measure of a rental assistance program is not just whether funds were distributed, but whether families stayed housedand this template helps you track exactly that.