Housing Intake Request

For veterans and case managers. Complete this form to begin the coordinated intake process. We respond within 48 hours.

Personal Information

Veteran's basic contact details

Military Service

Service history helps us connect you with the right VA resources

Housing Situation

Current housing details and location

Immediate Needs

Select all that apply. This helps us prepare the right services.

Additional Information

Referral Information

Optional. If a case manager or agency is making this referral.

All information is kept confidential and used only for housing intake purposes.
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Request Received

Your intake request has been submitted successfully. Our team will review it and reach out within 48 hours. If this is an emergency, please call 211 or visit your nearest VA emergency room.

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