Shelter Inc. intake form - HomeBase 2026

1. Click ‘Get Form’ to open the Shelter Inc. intake form - HomeBase in the editor.
2. Begin by filling in the referring agency details, including the agency name, contact person, and phone number.
3. Enter the client's information: full name, last name, date of birth, and contact numbers for home and work.
4. For additional clients, repeat the process for Client Name #2 and specify household size and number of children living with you.
5. Complete the income section by listing each family member's name, date of birth, sex, and income amount.
6. Provide details about housing status, including where the family slept last night and reasons for homelessness.
7. Fill out employment history for adults in the household, detailing current job status and previous employment if applicable.
8. Address health history by specifying any health problems affecting participation in programs.
9. Document any alcohol or drug history as required, including frequency and amounts used.
10. Indicate any priority considerations such as pregnancy or medical risks that may affect housing needs.
11. Finally, list all agencies currently assisting the client and ensure to sign at the bottom before submission.

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