MI MSHMIS Street & Shelter Intake Form (3.917A) 2019-2025 free printable template
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SEMIS Street & Shelter Intake Form (3.917A) Only Use for Street Outreach, Safe Haven and Emergency Shelter Projects Intake Date: Intake Staff/Case Manager: HOUSEHOLD INFORMATION Answer this section
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How to fill out MI MSHMIS Street & Shelter Intake Form
01
Begin by gathering personal information such as name, date of birth, and contact details.
02
Provide details about your current living situation, including if you are staying in a shelter or on the street.
03
Fill out any necessary demographic information, including gender, race, and ethnicity.
04
Answer questions regarding any physical or mental health issues, if applicable.
05
List any income sources or public assistance you may be receiving.
06
Indicate your housing history, including previous addresses and duration of stay.
07
Sign and date the form to certify the information provided.
Who needs MI MSHMIS Street & Shelter Intake Form?
01
Individuals experiencing homelessness or at risk of homelessness.
02
Those seeking access to emergency shelter or housing services.
03
Organizations and agencies that require data on homelessness for reporting and resource allocation.
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What is MI MSHMIS Street & Shelter Intake Form?
The MI MSHMIS Street & Shelter Intake Form is a standardized document used to collect information about individuals experiencing homelessness and utilizing street outreach or shelter services in Michigan.
Who is required to file MI MSHMIS Street & Shelter Intake Form?
Service providers and organizations that offer shelter or outreach services to homeless individuals are required to file the MI MSHMIS Street & Shelter Intake Form.
How to fill out MI MSHMIS Street & Shelter Intake Form?
To fill out the MI MSHMIS Street & Shelter Intake Form, providers need to gather necessary information from the individual seeking services, including demographics, housing history, and specific needs, and complete all required sections accurately.
What is the purpose of MI MSHMIS Street & Shelter Intake Form?
The purpose of the MI MSHMIS Street & Shelter Intake Form is to collect essential data to help assess the needs of homeless individuals, improve service delivery, and track progress in addressing homelessness in Michigan.
What information must be reported on MI MSHMIS Street & Shelter Intake Form?
The MI MSHMIS Street & Shelter Intake Form must report information such as the individual's name, date of birth, contact information, housing status, length of homelessness, and any special needs or vulnerabilities.
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