Intake Forms

Key to Document Names:

  • Light Entry = Universal Data Elements excluding length of time homeless 
  • Basic Entry = Universal Data Elements. The minimum required data to collect.
  • PLUS = Universal Data Elements and Additional Program Specific data elements required by the funder(s)
  • ES = Emergency Shelter
  • SO  = Street Outreach
  • VA-GPD  = Veteran Administration Grant Per Diem program
  • MOW = Meals on Wheels
  • SS = Social Services
  • CoC PSH = Continuum of Care-funded Permanent Supportive Housing

Entry Assessments

Interim Assessments

Exit Assessments

6 &12 Month Post-Exit Housing Follow-up Assessment
This assessment contains just 3 data elements and to be completed in ServicePoint, no form needed.  

NOTE: RHY, SSVF, VA and PATH forms are not provided by Lane County

Word format available on request to your System Administrator