Common Contracts

ACCEPTED HMIS Referral -HMIS print out Region 16 CSBG Service & Participant Agreement -Provide copy to participant Housing History Assessment Housing Search Case Plan -Provide copy to participant Confidentiality Agreement HMIS Program Enrollment -must...

Enrollment Agreement • June 23rd, 2021

• Contract Type
  Enrollment Agreement
• Filed
  June 23rd, 2021

Gender □ Female □ Male □ Other Household Size Military Status Is Participant a U.S. Citizen? Disability □ Yes □ No □ Veteran □ Yes □ Physical □ HIV/AIDS □ Active Military □ No □ Developmental □ SUD □ Chronic Health □ Mental Health

ACCEPTED HMIS Referral Region 16 CSBG Service & Participant Agreement -Provide copy to participant Housing History Assessment Housing Search Case Plan -Provide copy to participant Services Tracking Form Confidentiality Agreement HMIS Intake/Entry...

Enrollment Agreement • April 22nd, 2021

• Contract Type
  Enrollment Agreement
• Filed
  April 22nd, 2021

Gender: □ Female □ Male □ Other Household Size: Military Status: Is Participant a U.S. Citizen? Disability: □ Yes □ No □ Veteran □ Yes □ Physical □ HIV/AIDS □ Active Military □ No □ Developmental □ SUD □ Chronic Health □ Mental Health

ACCEPTED HMIS Referral Region 16 CSBG Service & Participant Agreement -Provide copy to participant Housing History Assessment Housing Search Case Plan -Provide copy to participant Services Tracking Form Confidentiality Agreement HMIS Intake/Entry...

Enrollment Agreement • March 25th, 2021

• Contract Type
  Enrollment Agreement
• Filed
  March 25th, 2021

Gender: □ Female □ Male □ Other Household Size: Military Status: Is Participant a U.S. Citizen? Disability: □ Yes □ No □ Veteran □ Yes □ Physical □ HIV/AIDS □ Active Military □ No □ Developmental □ SUD □ Chronic Health □ Mental Health