Helping The Homeless Program Intake Form

Authorization
I hereby understand that my personal details provided above are subject to disclosure for legal purposes and I authorize the specific facility to gather all the necessary details for my application to ensure the safety of both parties. - I acknowledge the right to restrict how my personal information is used and disclosed if I notify the practice.
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Please upload any type of identification you may have to prove your identity. (DL, SSC, Student ID, etc.).

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Homeless Program Intake Form