This is a universal intake form that lists all the universal data elements necessary for CoC and ESG funded projects.
Please use this universal intake form to inform your own agency's intake.
- Change of Current Residence/Living Situation to Prior Living Situation
- Addition of new question: Current Living Situation
- Additional set of conditional logic questions that will appear depending on the answer:
- Those questions are:
- Is the client going to have to leave their current living situation within 14 days?
- Has a subsequent residence been identified?
- Does an individual or family have resources or support networks to obtain other permanent housing?
- Has the client had a lease or ownership interest in a permanent housing unit in the last 60 days?
- Has the client moved 2 or more times in the last
- Addition of new question: Employment
- Addition of new question: Pregnancy / Parenthood
- Addition of new question: Permanent Connections
- Wording Changes/Picklist Changes:
- Wording Revisions to Current Living Situation
- Wording Revisions to Prior Living Situation
We encourage agencies to add questions or manipulate this form in a way that best fits the workflow of the agency, particularly if they serve multi-person households.