emergency shelter intake form

I. What Brings You Here

II. The Chorus of Inconvenient Statistics

III. Where Did You Sleep Last Night?

IV. If You Answered Yes...

V. Have You Ever Been Evicted?

VI. Certainly We Can All Agree

VII. Have You Received Any Income in the Past Thirty Days?

VIII. Do Your Co-Workers Know That You Have Lost Your Home?

IX. Are You Eligible for a Section 8 Voucher?

X. Has Your Physical Health Ever Caused You To Lose Your Housing?

XI. A Brief History of The Subprime Mortgage Loan Crisis

XII. Have You Ever Been Denied A Lease?

XIII. Thank You for Completing This Form