Intake Form
Fields marked with an * are required, other fields are not required, but we can help you more quickly if they are filled out.
  • If there are multiple adults in the family, each adult must complete an intake.  
  • If you have children, please include the information for each.

Family Promise of Pierce County does not provide direct cash benefits to clients.
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Email *
Security is important to us.  Do you want a copy of your answers emailed to the email you provide? *
If you believe any other person would view your email that would violate your privacy, please check "No"
Do you have children in your custody?
 *
Please select the closest match to your circumstance:
Your preferred First Name *
Your Last or Surname *
Your Best Phone Number to call or text? *
Mobile or cell number is best.  
If you do not have a phone number, enter 555 plus your birth date in month date year 555MMDDYYYY format, example 55509012002 for a birth date of 09-01-2002
Your Zip code? *
Zip Code of where you need help.
Do you want to fill out a full complete intake (required to receive direct services), or a short version? *
Completing the short intake will provide enough information for FPPC to contact you and make referrals as needed, however, in order to receive direct services such as shelter, a Complete Intake will need to be completed.  You can do the Short version, and update your other information at a later date.
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