Homeless Housing Network Application

Coordinated Entry is the access point for people who are experiencing homelessness or are at imminent risk of homeless. The application below will connect you to Coordinated Entry staff. The information provided below will not be shared with any agency without your permission.

Full Name*

First NameLast Name

Where did you sleep last night?*

Where are you currently located? *

If you answered "other, out of state, or other WA city" in the question above, please specify:

How long have you been in Chelan or Douglas County? *

Phone Number

E-mail

example@example.com

If you do not have a phone or email, what is the best way to contact you? For example, do you frequent shelters, library, Lighthouse, etc. ?

Date of Birth

Date

Are you between the ages of 18 -24?*

YesNo

Are you currently fleeing a dangerous situation?*

YesNo

Are you a veteran?*

YesNo

Gender Identity *

What is your race/ethnicity? *

How many members are in your household?*

What caused your situation?

Please tell us more about your situation:

Do you have pets?*

YesNo