Note to providers: Refer to the  for assistance in filling out this form.  	
Provider:       	Worker’s name:      	
1. Tenant details (lead tenant of household)
	
Name:	     	
Address:
	     	
Telephone:	     	Tenancy start date:	     	
2. Social housing application status
	
Application number:	     	Housing program:		
Application status:		If deferred, deferral end date:	     
	
Housing Needs Assessment segment:	 Very high need	
 High need
	 Moderate need	 Lower need	
3. Support arrangements
	
Do you have a support/case worker or an informal support critical to maintaining your tenancy? 
 Yes     No – go to section 4
	
Support Provider/s:	     	
Details:     
	
4. Issues relevant to housing (complete table on next page)	
5. Appropriate housing exit option	
  Long-term social housing (review application status)	
  Private housing:
               Private rental   National Rental Affordability Scheme    Other:         
	
Comments:      

Defer social housing application?	
 Yes     No
	If yes, until when?
(Between 3-6months)	                             
                                    
(Provider to complete )     	
6. Review     	Review Tenancy Plan in 3 or 6 mths	Date of review:	     	
				
7. Endorsement	
Tenant:	     	Provider:	     	
Date:	     	Date:	     	

4.  Issues relevant to housing 	Date:      	
Goal (what the tenant wants to achieve by the end of the transitional housing tenancy)
     
		
Issues (access and sustainability barriers to achieving housing outcome)	Support in place or opportunities for support
(what’s in place or is needed to overcome barriers)	Action to be taken (who, what, when)	
     

	     	     	
     	     

	     	
     	     

	     

     	     
	     

Guide to filling out the Tenancy Plan	
1.  Social housing application status:
Refer to the Referral Report (for initial information) and then the Tenant Report for up-to-date information on the tenant’s application status. 	
Field to complete	Options for response	
Application Status	APPR (Approved)	Application is approved	
	CANC (Cancelled)	Application has been cancelled	
	CLOS (Closed)	Application is closed as applicant has been allocated to a long-term social housing property	
	FURT (Further Information)	Further information required post approval	
	DEFE (Deferred)	Application has been deferred 	
	TRNH (Transitionally Housed)	Application has been deferred because the applicant is in transitional housing	
	HOLD (on Hold)	Further information is required to confirm eligibility for housing assistance. An application cannot be placed on HOLD once it has already been approved	
	OFFR (Offer)	Applicant is being made an offer of housing	
	INEL (Ineligible)	Applicant is deemed ineligible and application is not approved	
Housing Program	•	CRS – Community Rent Scheme
•	CMSU – Community-Managed Studio Units
•	SHDL – Same House Different Landlord	
Deferral end date	All new transitional housing tenants will have their application automatically deferred for three months from the date of allocation.  	
Housing Needs Assessment Segment	Applicants need to have a very high or high need to be eligible to receive transitional housing assistance.  Tenants in moderate or low need are to be assisted to exit to a private housing option. 	
2. Support arrangements:
This section captures information about any critical supports (whether formal or informal) that assist the tenant to maintain the tenancy.  This information may already be supplied in the Referral Report. With the tenant’s permission, the support person may be present during the process of developing the Tenancy Plan or may receive a copy. 	
3.	Issues relevant to housing:
This section identifies barriers the tenant is facing in accessing and sustaining long-term housing, including any issues arising from their transitional housing tenancy and support and actions required to address those barriers.    	
4.	Appropriate exit option:
The most appropriate exit option depends on what barriers to long-term housing the tenant is facing.  When the Tenancy Plan is reviewed, the selected exit option may be revised, depending on changes to the tenant’s circumstances.	
5.	Deferral of social housing application:
The tenant’s social housing application can be deferred if the tenant is not ready to independently sustain a long-term tenancy or social housing is not an appropriate exit option.  This decision is an outcome of the Tenancy Plan, as agreed to by the provider and tenant.  Each period of deferral should be for a maximum of 6 month and not more than 12 months in total.  	
6.	Review of Tenancy Plan:
The provider and tenant should decide when the Tenancy Plan should be reviewed based on the tenant’s circumstances and needs.  A review should take place within 6 months of the Tenancy Plan being developed.