Get Esg Client Intake Form - Tarrant County Homeless Coalition

The ESG Client Intake Form is an essential document for individuals seeking support from the Tarrant County Homeless Coalition. This guide will walk you through the process of completing the form online, ensuring you provide all necessary information accurately.

Follow the steps to complete your ESG Client Intake Form online.

1. Press the ‘Get Form’ button to access the ESG Client Intake Form. This action will allow you to open the form in your preferred editing tool.
2. Enter your personal information in the designated fields. This includes your name, date of birth (DOB), social security number (SSN), ethnicity, race, gender, marital status, military status, current employer, and total monthly income from employment.
3. If there is another adult in the household, provide their details in the same format as your information, including their name, DOB, SSN, ethnicity, race, gender, marital status, military status, current employer, and total monthly income from employment.
4. List the names and genders of others living in the home, along with their dates of birth. Ensure you include all individuals residing at the same address.
5. Indicate who referred you or your household to this program and answer whether the household was chronically homeless before entering the program.
6. Check all applicable disabilities from the options provided, such as alcohol abuse, HIV/AIDS, severe mental illness, or substance abuse.
7. Detail all cash income sources upon entering the program, including income from employment, SSDI, SSI, child support, veterans benefits, and any other relevant sources.
8. Provide the address of the housing unit where you will be housed, the anticipated move-in date, the number of bedrooms in the unit, the term of the lease, and details regarding monthly rent, security deposit, and client rent.
9. Outline any comments regarding your case management plan and include the name of your assigned case manager.
10. Attach a copy of the Housing Quality Standards (HQS) inspection checklist, as required.
11. Once all sections have been filled out thoroughly, review your information for accuracy, then save your changes. You may choose to download, print, or share the completed form as needed.

Take action today and complete your ESG Client Intake Form online to receive the support you need.