Vermont Unsheltered Point in Time Count (Demo Version)
Complete this form on:
Wednesday, January 31, 2018 (6PM – 6AM “Where are you currently staying?”)
OR Thursday, February 1, 2018 (6AM – 6PM “Where did you stay last night?”).

COMPLETE ALL 5 sections.

Please read questions carefully.  Note that you will have the opportunity to edit your responses at the end of the survey, if necessary.
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Agency Name
Staff/Volunteer Name (First & Last) *
Staff/Volunteer Phone & Email
Is this the first time you (or your team) are filling out a survey with this individual/family during this Point in Time? *
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