Follow the steps to successfully complete the intake form.

1. Click ‘Get Form’ button to obtain the form and open it in your document editor.
2. Begin by entering the referring agency name and contact information at the top of the form. This information is essential for processing the referral.
3. Fill in the date and the agency phone number to ensure that proper communication can take place.
4. Input the client’s full name including their date of birth, followed by their home phone, work phone, and any messages necessary for communication.
5. If applicable, fill out the second client’s information, including their last name and household size.
6. Detail the number of children living with you, followed by their names, dates of birth, sex, and income amount. Repeat this for each child in the household.
7. Calculate the total monthly household income and enter it in the designated field.
8. Answer the housing questions, including where you or your family slept last night, the address, and other relevant housing details.
9. Indicate the date you became homeless, and if applicable, provide the last permanent residence address.
10. Explain the reasons for homelessness and provide details about any previous stays at Shelter Inc. programs.
11. In the income and employment section, include where the primary working adult is employed, the duration of employment, and reasons for any job endings.
12. Complete the health history section, listing any health problems for family members that might impact participation in the program.
13. In the alcohol and drug history section, specify the last use of substances and current usage patterns, as well as interest in treatment if applicable.
14. Address any priority considerations such as pregnancy or medical risks, and whether the client has transportation.
15. Make any additional comments that might assist in processing the intake.
16. List all agencies and worker contacts currently assisting the client in achieving permanent housing.
17. Once all fields are completed, save your changes, and choose whether to download, print, or share the form as necessary.

Start filling out your Shelter Inc. Intake Form - HomeBase online today to access the support you need!