Demonstration Survey: Non-HMIS ES Point-in-Time Count
DEMONSTRATION PURPOSES ONLY. NOT TO BE USED IN THE NIGHT OF THE PIT. This is the 2017 version; the 2018 version will be updated prior to the count to reflect 2017 HUD Data Standards changes.

This survey is for non-HMIS emergency shelters for the night of Wednesday, January 24th, 2018. Please read questions carefully. Note that you will have the opportunity to edit your responses at the end of the survey, if necessary.

Location: County *
Provide county name.
Your answer
Team Name/Number
Your answer
Surveyor Name *
Your answer
Location: Specific *
List your agency name.
Your answer
Is this the first time you (or your team) are filling out a survey with this individual/family during this Point in Time? *
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service