Refugee Resettlement Case Intake Form — Form Fields
This nonprofit template includes 9 fields. Initial intake form for refugees seeking resettlement assistance and support services. Free to customize and use on ZenBuild.
Client Name (text, required)
Country of Origin (text, required)
Date of Arrival in Country (text, required)
Current Housing Situation (dropdown selection, required) — options: Temporary Shelter, Staying with Family/Friends, Hotel/Motel, No Housing, Other
Number of Family Members (number, required)
Primary Language (dropdown selection, required) — options: Arabic, Dari/Pashto, French, Spanish, Somali, Swahili, Other
Most Urgent Need (dropdown selection, required) — options: Housing, Employment, Language Classes, Medical Care, School Enrollment, Legal Assistance
Case Manager Assigned (text, optional)
Special circumstances or vulnerabilities (long text, optional)
