UNITY Warehouse Requisition Form
For UNITY and our partner organizations to request household goods and furniture for recently-housed, formerly homeless folks.

UNITY Warehouse
506 N. St. Patrick St.
New Orleans, LA 70119
(between Bienville St. and Orleans Ave., near City Park Ave.)

Our hours are:
Monday--Thursday 9AM - 1PM.

Phone: 504-483-9300
Fax: 504-486-7740

E-mail: homelesswarehouse@unitygno.org

Program staff should request available items through this form.  

Recently housed clients may make accompanied visits to the warehouse to select and pick-up available items.

Furniture and household goods are provided on an as available basis.
Sign in to Google to save your progress. Learn more
Client and Requisitioner Information
1) Client Name *
HMIS ID# or Client ID# *
Please enter client's unique HMIS or Client ID (for NOFJC/Metro) #.  Do NOT enter Social Security or State ID #.  
2) Address *
Client's Street Address, Unit #, City, and ZIP Code.
3) Client's Phone Number(s)
Primary & alternate numbers whenever delivery is requested, note when number belongs to an associate.
4) Case Worker / Housing Specialist *
Name of person submitting the requisition form and, when pertinent, a UNITY affiliated worker.
5) Agency and Program Name *
Name of Agency and Program for which Requisitioner works and/or which supports client.
6) Caseworker / Housing Specialist  Office Phone Number *
7) Caseworker / Housing Specialist  Cell Phone Number
8) Caseworker / Housing Specialist E-mail Address *
Client Data and Eligibility
9) Program List *
Please indicate what program is PAYING for clients' housing and/or case management services
10) Household Furnishings *
Is the client's apartment already furnished?
11) Income *
Does client have any income?
12) Veteran Status *
Has the client (or any member of their household) ever been a member of any branch of the Armed Forces?
13) Number in Household *
How many people are currently inhabiting this home?
14) Recent, Literal Homeless *
Has the client experienced recent, literal homelessness (slept primarily on the street, in a shelter, in a vehicle, or in an abandoned building)?
Starter Kit / Household Supplies / Furniture Request
15) Starter Kit (Kitchen Supplies, Bed & Bath Linens, Toiletry & Cleaning Supplies) [one per household member] *
Contents include tableware, cooking utensils and dishes; sheets, pillows and towels; toiletries and 1 or 2 house cleaning items. Kits must be picked up Monday - Thursday 9AM to 1PM.
16) Household Supplies
Please be specific.  Requested Household Supplies not included in Starter Kit (will be provided as available at the time of request).  
17) Requested Furniture Items
Please be specific.  Items will be provided as available at the time of request.  No waiting lists for items are kept.
18) Starter Kit / Household Supplies / Furniture Pick Up Date
Starter Kits must be picked up by program staff.  Please select the date (M-Th) you plan to come.
19) Planned Client Visit Date
Program staff is encouraged to bring clients to select items during regular warehouse hours.  If you plan to bring a client, please select the date (M-Th) you plan to bring your client.
20) Preferred Furniture Delivery Date
Deliveries are available for selected large furniture items on an "as available" basis. Deliveries take place Mon-Thu afternoon and throughout the day on Friday.
When completed, please print this page for your records before selecting "Submit."
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy