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Operation Hope-Vista Shelter                                    Client Pre-Screening Form
The Operation HOPE-Vista Shelter provides temporary shelter to homeless families with children and single women. We are a crisis bed 60 day shelter located in Vista, CA.

In order to be considered for admission, potential clients must complete this brief Pre-Screening Form, either over the phone or online. Our intake staff will then review your initial information. If you meet the eligibility criteria and a bed is available, we will contact you to schedule a full intake appointment.  The full intake appointment will require applicants pass an pre-admission drug test. Please be advised a clean drug test is required (medical marijuana not accepted) for admission to the shelter.  

Our Admission Criteria:
   - Must have some form of photo ID
   - Must have a social security number
   - No single adult males over the age of 18 without children admitted
   - No registered sex offenders
   - No individual who tests positive for drugs and alcohol, you must be sober and drug free
  -  Must be able to attend evening OHV classes/groups

If you are eligible but no beds are currently available, staff will place you on the Operation Hope- Vista Shelter Wait List. In order to keep your name on the Wait List, you must contact us again every 14 days, by phone at (760) 536-3880. For information on other local emergency shelters, food banks and community resources please call 2-1-1 or Access Crisis Line at (888)724-7240 or visit our website at www.operationhopeshelter.org.

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1. Name/Head of Household:
2. Gender:
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3. Primary Language:
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4. Phone Number:
5. Email:
6.  Date of Birth:  
7.  Are you an adult female seeking shelter just for yourself?  
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8.  For families, list total number of children in your household needing shelter.  (Children must be in your custody):
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9.  Describe total number of adults in your household needing shelter (anyone 18 years or older):  
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10. Where have you been staying the last 30 days?
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11. Can you briefly explain how you became homeless?
12. Do you or any other members of your household, have a diagnosed mental health condition?  
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13. Do you, or any members of your household, have a diagnosed physical or medical condition?
14. Are you, or anyone in your current household,  taking prescription medications on a regular basis?
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15. Have you or members of your household struggled with abuse of any drugs, prescription medications, or alcohol in the past year?
16. If you answered yes to the above question, for how long have you or your family member been clean and sober?
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17. Do you currently receive any monthly income, either from a job or other benefits?  (Please note that having income does not disqualify you from OHV services)
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18. Do you have some form of picture ID?
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19. Do you have your Social Security Number?
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20. How long have you been homeless?
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21. Have you stayed in a shelter before?
22. Are you willing to complete our Operation HOPE-Vista Shelter 60 Day Program Requirements:     1) meet weekly with a case manager, 2) attend evening classes/groups, 3) save 25%-30% of your monthly income, 4) apply for jobs or federal assistance, 5) work on getting housing?
23. What city are you living in currently?
24. Please provide any other information that you think we should know about your situation:
Thank you for your interest in the Operation HOPE-Vista Shelter & Bridge Housing Program. Our Intake Coordinator will be contacting you to follow up.
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