emergency shelter intake form

I. What Brings You Here?

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II. The Chorus of Inconvenient Statistics

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III. Where Did You Sleep Last Night?

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IV. If You Answered "Yes"

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V. Have You Ever Been Evicted?

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VI. Certainly We Can All Agree

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VII. Have You Received Any Income in the Past 30 Days?

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VIII. Do Your Co-Workers Know That You Have Lost Your Home?

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IX. Are You Eligible for a Section 8 Voucher?

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X. Has Your Physical Health Ever Caused You to Lose Your Housing?

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XI. A Brief History of the Subprime Mortgage Loan Crisis

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XII. Have You Ever Been Denied a Lease?

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XIII. Thank You for Completing This Form

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