Coordinated Entry Intake
Coordinated Entry is a streamlined system designed to efficiently match people experiencing homelessness or those at-risk of homelessness to available housing, shelter, and services. It prioritizes those who are most in need of assistance and provides crucial information that helps the Continuum of Care strategically allocate resources.
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Phone Number
Email
Are you homeless?
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Which service are you seeking today?
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How much assistance do you need? *
First & Last Name
Date of Birth
MM
/
DD
/
YYYY
SSN
US Veteran
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Branch of Military
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Discharge Status
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Household Type
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Race
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Ethnicity
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Gender
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Homelessness Primary Reason
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If homeless how long (Years and Months)
If in housing how long (Years and Months)
Other Members in Household Names, DOB, SSN, Gender, Race, Ethnicity, Veteran Status
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This form was created inside of Collier County Hunger & Homeless Coalition.