Follow the steps to successfully complete the intake form.

1. Click the ‘Get Form’ button to obtain the form and access it in your preferred digital format.
2. Begin filling out the form by entering your personal information, including your first name, middle initial, and last name.
3. In the designated area, provide the last four digits of your Social Security number and your date of birth.
4. Indicate your gender by checking one of the provided options. Make sure to select the option that best describes your identity.
5. Select your primary race from the options given. This helps in understanding the demographic data of users accessing these services.
6. Identify your household type by checking the appropriate box. Choose from options such as adult household without children or households with children.
7. Complete the household totals section by indicating the number of people in your household, including those over 24 years, aged 18-24, and under 18. Specify the number of individuals with disabilities if applicable.
8. Select where you slept last night. Only check one box from the options available, reflecting your current situation.
9. Indicate if any circumstances have affected your ability to maintain housing by checking all relevant options.
10. Answer if you are currently fleeing a domestic violence situation with a yes or no.
11. Respond to whether you are a veteran by selecting yes or no, and provide how long you have been without permanent housing.
12. Indicate whether you have received an eviction notice this month by selecting yes or no.
13. Identify the primary reason for your homelessness or impending eviction by checking only one option that best describes your situation.
14. State your employment status by choosing yes or no.
15. Detail your primary sources of cash in the last 30 days, selecting the most appropriate options.
16. Complete the health care information section, indicating whether you are currently using any health care services.
17. Finally, sign the consent form on the back, if applicable. Ensure that all information is accurately filled in.
18. Once all sections are completed, save your changes, and choose whether to download, print, or share the completed form as needed.

Complete your intake form online today to ensure you access the necessary resources and support.