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Homeless Shelter Intake Form - Free Nonprofit Template | ZenBuild | ZenBuild

Templates→Nonprofit→Homeless Shelter Intake Form

Homeless Shelter Intake Form

Screen and intake individuals and families seeking emergency shelter services at your nonprofit facility.

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Homeless Shelter Intake Form

Welcome. Please complete this intake form to help us connect you with the right services and accommodations. All information is kept confidential.

Full Name*

Date of Birth*

Are you seeking shelter for yourself alone or with others?*

Myself onlyMyself and childrenMyself and partner/spouseFamily (two adults + children)

Number of people in your group (including yourself)*

Which services do you need? (Select all that apply)

Emergency ShelterMeals / FoodMedical ReferralCase ManagementMental Health SupportJob Placement Assistance

Do you have any medical conditions or special needs we should be aware of?*

Yes — I will discuss with staffNo

Emergency Contact Name & Phone

Template Details

CategoryNonprofit

Fields7

Uses0

Views0

nonprofitshelterintakesocial-serviceshousing