Committee for Social Justice Intake form
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Full Legal Name *
What is the best way to reach you? *
Email (you check regularly) *
Phone number *
Other Phone number (perhaps a family or friend's so we have a backup way to reach you)
Please give us an idea of why you are contacting us (Please include: All important information, such as: when, where, who were the parties involved, additional important details)
Were you offered any shelter or social services during the interaction? If so which?
What is your living situation? *
If you are living in a shelter, which one?
Do you live in Santa Barbara County? *
if Yes, do you plan to continue to live in this area for the next 6 months? *
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