Check In
Enter Phone Number
Digits only (e.g., 8885551212)
Format: (000) 000-0000.
If Student, Enter Student ID
Enter Student ID
Enter Your 9 Digit School ID
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Check In Form
Neighborhood Wellness
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Name
First Name
Last Name
Phone Number
Format: (000) 000-0000.
Student ID
Email
Date
*
-
Month
-
Day
Year
Date
Race/Ethnicity
*
African American
Hispanic
AAPI
White
Afghan/Middle Eastern
Native American
Reason for the Check In
*
Parent Cafe
Healing Circle
Mentoring
PTS Student Health
Unhoused
Career Matriculation
Vocational Training
Educational Sessions/Training
Employment
HMIS
Community Service
Take Space
Leadership Meeting
Concrete Needs
Food
Staff Meetings
DUI Support
Transportation
Volunteer
Social Services
Narcan
Admin
Clothing
Case Management
Board Meeting
Other
Birthday
-
Month
-
Day
Year
Date
Concrete Needs?
Rental/Mortgage Assistance
Groceries
Transportation
Utilities
Debt Assistance
Car repair
Emergency Stay
Children’s Needs
Lyft/Uber
Home Maintenance
Formula/Diapers
Medical
Move-in Costs
Clothing
Dental
Eviction Mitigation
IDs
Mental Health
Essential Furnishing
Employment Assistance
Funeral Expenses
Hours Worked
Who's Helping
Please Select
Pinkey Booker
Sam Dinkins
Les Jones
Sherri Kirk
Fade Dorrough
Renea Saucier
Dooney Payne
Sonia Smith
Gina Warren
Laurin Williams
Marilyn Woods
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Contact ID
Contact ID from Salesforce record if Phone Number match is found.
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