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EXHIBIT 1 <br />Living Situation: Emergency Shelter <br />❑ The person(s) named above is/are currently living in (or, if currently in hospital or other <br />institution, was living in immediately prior to hospital/institution admission) a supervised publicly or <br />privately operated shelter as follows: <br />Emergency Shelter Program Name: <br />This emergency shelter must appear on the CoC's Housing Inventory Chart submitted as part of the <br />most recent CoC Homeless Assistance application to HUD or otherwise be recognized by the CoC as <br />part of the CoC inventory (e.g., newly established Emergency Shelter). <br />Authorized Agency Representative Signature: <br />Living Situation: Recently Homeless <br />Date <br />❑ The person(s) named above is/are currently receiving financial and supportive services for persons <br />who are homeless. Loss of such assistance would result in a return to homelessness (ex. Households in <br />Rapid Rehousing Programs, residents of Permanent Supportive Housing Programs participating in <br />Moving On, etc.) <br />Authorized Agency Representative Signature: <br />This referring agency must appear on the CoC's Housing Inventory Chart submitted as part of the <br />most recent CoC Homeless Assistance application to HUD or otherwise be recognized by the CoC as <br />part of the CoC inventory. <br />Immediately prior to entering the household's current living situation, the person(s) named <br />above was/were residing in: <br />❑ emergency shelter OR ❑ a place unfit for human habitation <br />Authorized Agency Representative Signature: <br />Date: <br />Page TPS-35 Administrative Plan 7/l/2025 <br />City Council <br />5 — 935 7/15/2025 <br />