Get Shalom Bintake Questionnaireb

Filling out the SHALOM BIntake Questionnaireb online is a crucial step for individuals seeking assistance. This guide provides clear instructions to help users navigate each section of the form with ease and confidence.

Follow the steps to complete the questionnaire effectively.

1. Click ‘Get Form’ button to access the form and open it for editing.
2. Fill in the intake date and the intake person's name at the top of the form. This helps to identify when the questionnaire was completed and who assisted the user.
3. Provide the county of residence. This information is essential for determining local resources available to the user.
4. Print the full name of the user clearly. This ensures that the information is accurately recorded.
5. Enter the Social Security Number (SSN). This is needed for identification purposes but should be handled securely.
6. Indicate the user's gender and race, and provide the birth date. These fields help in understanding the demographic needs.
7. Answer whether the user is a veteran. This information can affect eligibility for certain services.
8. Indicate if the user graduated from high school and the highest grade attended. If interested, mark the option for obtaining a GED.
9. Provide a brief explanation for homelessness, alongside the duration of homelessness. This helps to tailor support services to the user's situation.
10. Document how the user came to be in their current situation. This provides context for the services being sought.
11. Indicate whether the user has a case worker, and if so, include their name and agency. This assists in coordinating care.
12. Answer questions about past incarceration, including the location, offense, and date, if applicable.
13. Verify if there are any outstanding warrants. This is crucial for the user's legal safety.
14. If applicable, communicate with the indicated resource to verify no warrants.
15. Indicate employment status, last working date, and workplace details. Understanding current employment situations helps in resource allocation.
16. List job skills. This information is vital for job placement services.
17. Document any assistance received, including food stamps, Medicaid, or cash assistance.
18. Provide details regarding any problems with substance abuse, mental health, or physical issues, and explain briefly.
19. List any medications the user is currently taking along with the type and doctor's information.
20. Identify an emergency contact with their phone number and the last date of communication.
21. The user should sign and date the questionnaire. This indicates the information is accurate and submitted deliberately.
22. Once completed, save the changes made to the questionnaire, and consider downloading, printing, or sharing the form as needed.

Begin filling out the SHALOM BIntake Questionnaireb online now and access the assistance you need.