Coordinated Entry Eligibility Screening

Coordinated Entry Eligibility Screening
If you are currently experiencing homelessness,

Fill out the form below to determine eligibility for services
To determine eligibility for services you can either:

Call 1-253-426-1513 anytime, 24 hours a day, 7 days a week to be connected to an automated representative to determine eligibility for services. If eligible, you will be scheduled for an appointment with a Coordinated Entry Housing Specialist. If not eligible, you be given an option to connect with a Housing Navigation Resource Specialist for support.

Or you can complete the form below to have a Coordinated Entry Housing Specialist contact you directly to determine eligibility.

*Please do not do both - duplicate submissions slow down the process.
***PLEASE NOTE***

This form is NOT for rental assistance. Please call 2-1-1 for rental Assistance.
Name

First NameLast Name
Phone Number
Please enter a valid phone number.(Do NOT include a 1 at the beginning.)Format: (000) 000-0000.
Email
example@example.com
Head of Household's Age
Preferred Method of Contact
If you have a phone, what type of phone plan do you currently have?
Are you currently in fear of your safety due to domestic violence?
Is it safe to leave a message?
Did you sleep in Pierce County, WA last night?
Where did you sleep last night?
How was the Hotel/Motel paid for?
Were you in the facility for 90 days or more?
Before entering the facility where did you sleep?
Assigned Staff
Contact Status
Screening Result
Source
Notes
Please verify that you are human
Should be Empty:

Coordinated Entry Eligibility Screening

If you are currently experiencing homelessness,

***PLEASE NOTE***

PLEASE NOTE