Mountain Homeless Coalition Intake Form
If you are a resident of the San Bernardino mountain areas and are experiencing or at-risk of homelessness, please complete this simple intake form. This is not an emergency response resource. If you are currently facing an emergency health and/or safety concern, please call 911; or, if you otherwise require immediate attention for your situation, please call 211. The questions are designed to collect basic household profile information along with information related to your current housing challenges in order to help identify potential resources available for your situation for which you might be eligible. If we have a service or potential resource available to assist with your housing challenge, we will reach out to you directly. We encourage you to continue to independently pursue all potential options that might be available to you at this time.